Electrosurgical instrument with monopolar and bipolar energy capabilities

ABSTRACT

An electrosurgical instrument comprising an end effector including a first jaw, a second jaw, and an electrical circuit is disclosed. The first jaw comprises a first conductive skeleton, a first insulative coating selectively covering portions of the first conductive skeleton, and first-jaw electrodes comprising exposed portions of the first conductive skeleton. The second jaw comprises a second conductive skeleton, a second insulative coating selectively covering portions of the second conductive skeleton, and second-jaw electrodes comprising exposed portions of the second conductive skeleton. The circuit is configured to transmit a bipolar RF energy and a monopolar RF energy to the tissue through the first-jaw electrodes and the second-jaw electrodes. The monopolar RF energy shares a first electrical pathway and a second electrical pathway defined by the electrical circuit for transmission of the bipolar RF energy.

CROSS REFERENCE TO RELATED APPLICATION

This non-provisional application claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Patent Application Ser. No. 62/955,299,entitled DEVICES AND SYSTEMS FOR ELECTROSURGERY, filed Dec. 30, 2019,the disclosure of which is incorporated by reference herein in itsentirety.

BACKGROUND

The present invention relates to surgical instruments designed to treattissue, including but not limited to surgical instruments that areconfigured to cut and fasten tissue. The surgical instruments mayinclude electrosurgical instruments powered by generators to effecttissue dissecting, cutting, and/or coagulation during surgicalprocedures. The surgical instruments may include instruments that areconfigured to cut and staple tissue using surgical staples and/orfasteners. The surgical instruments may be configured for use in opensurgical procedures, but have applications in other types of surgery,such as laparoscopic, endoscopic, and robotic-assisted procedures andmay include end effectors that are articulatable relative to a shaftportion of the instrument to facilitate precise positioning within apatient.

SUMMARY

In various embodiments, an electrosurgical instrument comprising an endeffector is disclosed. The end effector comprises a first jaw, a secondjaw, and an electrical circuit. The first jaw comprises a firstelectrically conductive skeleton, a first insulative coating selectivelycovering portions of the first electrically conductive skeleton, andfirst-jaw electrodes comprising exposed portions of the firstelectrically conductive skeleton. At least one of the first jaw and thesecond jaw is movable to transition the end effector from an openconfiguration to a closed configuration to grasp tissue therebetween.The second jaw comprises a second electrically conductive skeleton, asecond insulative coating selectively covering portions of the secondelectrically conductive skeleton, and second-jaw electrodes comprisingexposed portions of the second electrically conductive skeleton. Theelectrical circuit is configured to transmit a bipolar RF energy and amonopolar RF energy to the tissue through the first-jaw electrodes andthe second-jaw electrodes. The monopolar RF energy shares a firstelectrical pathway and a second electrical pathway defined by theelectrical circuit for transmission of the bipolar RF energy.

In various embodiments, an electrosurgical instrument comprising an endeffector and an electrical circuit is disclosed. The end effectorcomprises at least two electrode sets, a first jaw, and a second jaw. Atleast one of the first jaw and the second jaw is movable to transitionthe end effector from an open configuration to a closed configuration tograsp tissue therebetween. The end effector is configured to deliver acombination of bipolar RF energy and monopolar RF energy to the graspedtissue from the at least two electrode sets. The electrical circuit isconfigured to transmit the bipolar RF energy and the monopolar RFenergy. The monopolar RF energy shares an active pathway and a returnpathway defined by the electrical circuit for transmission of thebipolar RF energy.

In various embodiments, an electrosurgical instrument comprising an endeffector is disclosed. The end effector comprises a first jaw and asecond jaw. At least one of the first jaw and the second jaw is movableto transition the end effector from an open configuration to a closedconfiguration to grasp tissue therebetween. The second jaw comprises acomposite skeleton of at least two different materials that areconfigured to selectively yield electrically conductive portions andthermally insulted portions.

In various embodiments, a method for manufacturing a jaw of an endeffector of an electrosurgical instrument is disclosed. The methodcomprises preparing a composite skeleton of the jaw by fusing a titaniumpowder with a ceramic powder in a metal injection molding process andselectively coating the composite skeleton with an electricallyinsulative material to yield a plurality of electrodes.

DRAWINGS

The novel features of the various aspects are set forth withparticularity in the appended claims. The described aspects, however,both as to organization and methods of operation, may be best understoodby reference to the following description, taken in conjunction with theaccompanying drawings in which:

FIG. 1 illustrates an example of a generator for use with a surgicalsystem, in accordance with at least one aspect of the presentdisclosure;

FIG. 2 illustrates one form of a surgical system comprising a generatorand an electrosurgical instrument usable therewith, in accordance withat least one aspect of the present disclosure;

FIG. 3 illustrates a schematic diagram of a surgical instrument or tool,in accordance with at least one aspect of the present disclosure;

FIG. 4 is an exploded view of an end effector of an electro surgicalinstrument, in accordance with at least one aspect of the presentdisclosure;

FIG. 5 is a cross-sectional view of the of the end effector of FIG. 4;

FIGS. 6-8 depict three different operational modes of the end effectorof FIG. 4 prior to energy application to tissue;

FIGS. 9-11 depict three different operational modes of the end effectorof FIG. 4 during energy application to tissue;

FIG. 12 illustrates a method of manufacturing a jaw of an end effector,in accordance with at least one aspect of the present disclosure;

FIG. 13 illustrates a method of manufacturing a jaw of an end effector,in accordance with at least one aspect of the present disclosure;

FIG. 14 illustrates a partial perspective view of a jaw of an endeffector of an electrosurgical instrument, in accordance with at leastone aspect of the present disclosure;

FIG. 15 illustrates steps of a process of manufacturing the jaw of FIG.14;

FIG. 16 illustrates steps of a process of manufacturing the jaw of FIG.14;

FIGS. 17-19 illustrates steps of a process of manufacturing the jaw ofFIG. 14;

FIG. 20 illustrates a cross-sectional view of a jaw of an end effectorof an electrosurgical instrument taken through line 20-20 in FIG. 22, inaccordance with at least one aspect of the present disclosure;

FIG. 21 illustrates a cross-sectional view of the jaw of the endeffector of the electrosurgical instrument taken through line 21-21 inFIG. 22;

FIG. 22 illustrates a perspective view of the jaw of the end effector ofthe electrosurgical instrument of FIG. 20;

FIG. 23 illustrates a cross-sectional view of a jaw of an end effectorof an electrosurgical instrument, in accordance with at least one aspectof the present disclosure;

FIG. 24 illustrates a partial perspective view of a jaw of an endeffector of an electrosurgical instrument, in accordance with at leastone aspect of the present disclosure;

FIG. 25 illustrates a cross-sectional view of an end effector of anelectrosurgical instrument, in accordance with at least one aspect ofthe present disclosure;

FIG. 26 illustrates a partial exploded view of an end effector of anelectrosurgical instrument, in accordance with at least one aspect ofthe present disclosure;

FIG. 27 illustrates an exploded perspective assembly view of a portionof an electrosurgical instrument including an electrical connectionassembly, in accordance with at least one aspect of the presentdisclosure;

FIG. 28 illustrates a top view of electrical pathways defined in thesurgical instrument portion of FIG. 27, in accordance with at least oneaspect of the present disclosure;

FIG. 29 illustrates a cross-sectional view of a flex circuit, inaccordance with at least one aspect of the present disclosure;

FIG. 30 illustrates a cross-sectional view of a flex circuit extendingthrough a coil tube, in accordance with at least one aspect of thepresent disclosure;

FIG. 31 illustrates a cross-sectional view of a flex circuit extendingthrough a coil tube, in accordance with at least one aspect of thepresent disclosure;

FIG. 32 illustrates a cross-sectional view of a flex circuit extendingthrough a coil tube, in accordance with at least one aspect of thepresent disclosure;

FIG. 33 illustrates a cross-sectional view of a flex circuit extendingthrough a coil tube, in accordance with at least one aspect of thepresent disclosure;

FIG. 34 is a graph illustrating a power scheme for coagulating andcutting a tissue treatment region in a treatment cycle applied by an endeffector, in accordance with at least one aspect of the presentdisclosure;

FIG. 35 is a graph illustrating a power scheme for coagulating andcutting a tissue treatment region in a treatment cycle applied by an endeffector and a number of measured parameters of the end effector and thetissue, in accordance with at least one aspect of the presentdisclosure;

FIG. 36 is a schematic diagram of an electrosurgical system, inaccordance with at least one aspect of the present disclosure;

FIG. 37 is a table illustrating a power scheme for coagulating andcutting a tissue treatment region in a treatment cycle applied by an endeffector, in accordance with at least one aspect of the presentdisclosure;

FIGS. 38-40 illustrate a tissue treatment cycle applied by an endeffector to a tissue treatment region, in accordance with at least oneaspect of the present disclosure;

FIG. 41 illustrates an end effector applying therapeutic energy to atissue grasped by the end effector, the therapeutic energy generated bya monopolar power source and a bipolar power source, in accordance withat least one aspect of the present disclosure;

FIG. 42 illustrates a simplified schematic diagram of an electrosurgicalsystem, in accordance with at least one aspect of the presentdisclosure;

FIG. 43 is a graph illustrating a power scheme for coagulating andcutting a tissue treatment region in a treatment cycle applied by an endeffector and corresponding temperature readings of the tissue treatmentregion, in accordance with at least one aspect of the presentdisclosure;

FIG. 44 illustrate an end effector treating an artery, in accordancewith at least one aspect of the present disclosure;

FIG. 45 illustrate an end effector treating an artery, in accordancewith at least one aspect of the present disclosure;

FIG. 46 illustrates an end effector applying therapeutic energy to atissue grasped by the end effector, the therapeutic energy generated bya monopolar power source and a bipolar power source, in accordance withat least one aspect of the present disclosure;

FIG. 47 illustrates a simplified schematic diagram of an electrosurgicalsystem, in accordance with at least one aspect of the presentdisclosure;

FIG. 48 is a graph illustrating a power scheme including a therapeuticportion for coagulating and cutting a tissue treatment range in atreatment cycle applied by an end effector, and non-therapeutic range,in accordance with at least one aspect of the present disclosure; and

FIG. 49 is a graph illustrating a power scheme including for coagulatingand cutting a tissue treatment range in a treatment cycle applied by anend effector, and corresponding monopolar and bipolar impedances and aratio thereof, in accordance with at least one aspect of the presentdisclosure.

DESCRIPTION

Applicant of the present application owns the following U.S. patentapplications that are filed on even date herewith, and which are eachherein incorporated by reference in their respective entireties:

Attorney Docket No. END9234USNP1/190717-1M, entitled METHOD FOR ANELECTROSURGICAL PROCEDURE;

Attorney Docket No. END9234USNP2/190717-2, entitled ARTICULATABLESURGICAL INSTRUMENT;

Attorney Docket No. END9234USNP3/190717-3, entitled SURGICAL INSTRUMENTWITH JAW ALIGNMENT FEATURES;

Attorney Docket No. END9234USNP4/190717-4, entitled SURGICAL INSTRUMENTWITH ROTATABLE AND ARTICULATABLE SURGICAL END EFFECTOR;

Attorney Docket No. END9234USNP5/190717-5, entitled ELECTROSURGICALINSTRUMENT WITH ASYNCHRONOUS ENERGIZING ELECTRODES;

Attorney Docket No. END9234USNP6/190717-6, entitled ELECTROSURGICALINSTRUMENT WITH ELECTRODES BIASING SUPPORT;

Attorney Docket No. END9234USNP7/190717-7, entitled ELECTROSURGICALINSTRUMENT WITH FLEXIBLE WIRING ASSEMBLIES;

Attorney Docket No. END9234USNP8/190717-8, entitled ELECTROSURGICALINSTRUMENT WITH VARIABLE CONTROL MECHANISMS;

Attorney Docket No. END9234USNP9/190717-9, entitled ELECTROSURGICALSYSTEMS WITH INTEGRATED AND EXTERNAL POWER SOURCES;

Attorney Docket No. END9234USNP10/190717-10, entitled ELECTROSURGICALINSTRUMENTS WITH ELECTRODES HAVING ENERGY FOCUSING FEATURES;

Attorney Docket No. END9234USNP11/190717-11, entitled ELECTROSURGICALINSTRUMENTS WITH ELECTRODES HAVING VARIABLE ENERGY DENSITIES;

Attorney Docket No. END9234USNP13/190717-13, entitled ELECTROSURGICALEND EFFECTORS WITH THERMALLY INSULATIVE AND THERMALLY CONDUCTIVEPORTIONS;

Attorney Docket No. END9234USNP14/190717-14, entitled ELECTROSURGICALINSTRUMENT WITH ELECTRODES OPERABLE IN BIPOLAR AND MONOPOLAR MODES;

Attorney Docket No. END9234USNP15/190717-15, entitled ELECTROSURGICALINSTRUMENT FOR DELIVERING BLENDED ENERGY MODALITIES TO TISSUE;

Attorney Docket No. END9234USNP16/190717-16, entitled CONTROL PROGRAMADAPTATION BASED ON DEVICE STATUS AND USER INPUT;

Attorney Docket No. END9234USNP17/190717-17, entitled CONTROL PROGRAMFOR MODULAR COMBINATION ENERGY DEVICE; and

Attorney Docket No. END9234USNP18/190717-18, entitled SURGICAL SYSTEMCOMMUNICATION PATHWAYS.

Applicant of the present application owns the following U.S. ProvisionalPatent applications that were filed on Dec. 30, 2019, the disclosure ofeach of which is herein incorporated by reference in its entirety:

U.S. Provisional Patent Application Ser. No. 62/955,294, entitled USERINTERFACE FOR SURGICAL INSTRUMENT WITH COMBINATION ENERGY MODALITYEND-EFFECTOR;

U.S. Provisional Patent Application Ser. No. 62/955,292, entitledCOMBINATION ENERGY MODALITY END-EFFECTOR; and

U.S. Provisional Patent Application Ser. No. 62/955,306, entitledSURGICAL INSTRUMENT SYSTEMS.

Applicant of the present application owns the following U.S. patentapplications, the disclosure of each of which is herein incorporated byreference in its entirety:

U.S. patent application Ser. No. 16/209,395, titled METHOD OF HUBCOMMUNICATION, now U.S. Patent Application Publication No. 2019/0201136;

U.S. patent application Ser. No. 16/209,403, titled METHOD OF CLOUDBASED DATA ANALYTICS FOR USE WITH THE HUB, now U.S. Patent ApplicationPublication No. 2019/0206569;

U.S. patent application Ser. No. 16/209,407, titled METHOD OF ROBOTICHUB COMMUNICATION, DETECTION, AND CONTROL, now U.S. Patent ApplicationPublication No. 2019/0201137;

U.S. patent application Ser. No. 16/209,416, titled METHOD OF HUBCOMMUNICATION, PROCESSING, DISPLAY, AND CLOUD ANALYTICS, now U.S. PatentApplication Publication No. 2019/0206562;

U.S. patent application Ser. No. 16/209,423, titled METHOD OFCOMPRESSING TISSUE WITHIN A STAPLING DEVICE AND SIMULTANEOUSLYDISPLAYING THE LOCATION OF THE TISSUE WITHIN THE JAWS, now U.S. PatentApplication Publication No. 2019/0200981;

U.S. patent application Ser. No. 16/209,427, titled METHOD OF USINGREINFORCED FLEXIBLE CIRCUITS WITH MULTIPLE SENSORS TO OPTIMIZEPERFORMANCE OF RADIO FREQUENCY DEVICES, now U.S. Patent ApplicationPublication No. 2019/0208641;

U.S. patent application Ser. No. 16/209,433, titled METHOD OF SENSINGPARTICULATE FROM SMOKE EVACUATED FROM A PATIENT, ADJUSTING THE PUMPSPEED BASED ON THE SENSED INFORMATION, AND COMMUNICATING THE FUNCTIONALPARAMETERS OF THE SYSTEM TO THE HUB, now U.S. Patent ApplicationPublication No. 2019/0201594;

U.S. patent application Ser. No. 16/209,447, titled METHOD FOR SMOKEEVACUATION FOR SURGICAL HUB, now U.S. Patent Application Publication No.2019/0201045;

U.S. patent application Ser. No. 16/209,453, titled METHOD FORCONTROLLING SMART ENERGY DEVICES, now U.S. Patent ApplicationPublication No. 2019/0201046;

U.S. patent application Ser. No. 16/209,458, titled METHOD FOR SMARTENERGY DEVICE INFRASTRUCTURE, now U.S. Patent Application PublicationNo. 2019/0201047;

U.S. patent application Ser. No. 16/209,465, titled METHOD FOR ADAPTIVECONTROL SCHEMES FOR SURGICAL NETWORK CONTROL AND INTERACTION, now U.S.Patent Application Publication No. 2019/0206563;

U.S. patent application Ser. No. 16/209,478, titled METHOD FORSITUATIONAL AWARENESS FOR SURGICAL NETWORK OR SURGICAL NETWORK CONNECTEDDEVICE CAPABLE OF ADJUSTING FUNCTION BASED ON A SENSED SITUATION ORUSAGE, now U.S. Patent Application Publication No. 2019/0104919;

U.S. patent application Ser. No. 16/209,490, titled METHOD FOR FACILITYDATA COLLECTION AND INTERPRETATION, now U.S. Patent ApplicationPublication No. 2019/0206564;

U.S. patent application Ser. No. 16/209,491, titled METHOD FOR CIRCULARSTAPLER CONTROL ALGORITHM ADJUSTMENT BASED ON SITUATIONAL AWARENESS, nowU.S. Patent Application Publication No. 2019/0200998;

U.S. patent application Ser. No. 16/562,123, titled METHOD FORCONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLEDEVICES;

U.S. patent application Ser. No. 16/562,135, titled METHOD FORCONTROLLING AN ENERGY MODULE OUTPUT;

U.S. patent application Ser. No. 16/562,144, titled METHOD FORCONTROLLING A MODULAR ENERGY SYSTEM USER INTERFACE; and

U.S. patent application Ser. No. 16/562,125, titled METHOD FORCOMMUNICATING BETWEEN MODULES AND DEVICES IN A MODULAR SURGICAL SYSTEM.

Before explaining various aspects of an electrosurgical system indetail, it should be noted that the illustrative examples are notlimited in application or use to the details of construction andarrangement of parts illustrated in the accompanying drawings anddescription. The illustrative examples may be implemented orincorporated in other aspects, variations, and modifications, and may bepracticed or carried out in various ways. Further, unless otherwiseindicated, the terms and expressions employed herein have been chosenfor the purpose of describing the illustrative examples for theconvenience of the reader and are not for the purpose of limitationthereof. Also, it will be appreciated that one or more of thefollowing-described aspects, expressions of aspects, and/or examples,can be combined with any one or more of the other following-describedaspects, expressions of aspects, and/or examples.

Various aspects are directed to electrosurgical systems that includeelectrosurgical instruments powered by generators to effect tissuedissecting, cutting, and/or coagulation during surgical procedures. Theelectrosurgical instruments may be configured for use in open surgicalprocedures, but has applications in other types of surgery, such aslaparoscopic, endoscopic, and robotic-assisted procedures.

As described below in greater detail, an electrosurgical instrumentgenerally includes a shaft having a distally-mounted end effector (e.g.,one or more electrodes). The end effector can be positioned against thetissue such that electrical current is introduced into the tissue.Electrosurgical instruments can be configured for bipolar or monopolaroperation. During bipolar operation, current is introduced into andreturned from the tissue by active and return electrodes, respectively,of the end effector. During monopolar operation, current is introducedinto the tissue by an active electrode of the end effector and returnedthrough a return electrode (e.g., a grounding pad) separately located ona patient's body. Heat generated by the current flowing through thetissue may form hemostatic seals within the tissue and/or betweentissues and thus may be particularly useful for sealing blood vessels,for example.

FIG. 1 illustrates an example of a generator 900 configured to delivermultiple energy modalities to a surgical instrument. The generator 900provides RF and/or ultrasonic signals for delivering energy to asurgical instrument. The generator 900 comprises at least one generatoroutput that can deliver multiple energy modalities (e.g., ultrasonic,bipolar or monopolar RF, irreversible and/or reversible electroporation,and/or microwave energy, among others) through a single port, and thesesignals can be delivered separately or simultaneously to an end effectorto treat tissue. The generator 900 comprises a processor 902 coupled toa waveform generator 904. The processor 902 and waveform generator 904are configured to generate a variety of signal waveforms based oninformation stored in a memory coupled to the processor 902, not shownfor clarity of disclosure. The digital information associated with awaveform is provided to the waveform generator 904 which includes one ormore DAC circuits to convert the digital input into an analog output.The analog output is fed to an amplifier 906 for signal conditioning andamplification. The conditioned and amplified output of the amplifier 906is coupled to a power transformer 908. The signals are coupled acrossthe power transformer 908 to the secondary side, which is in the patientisolation side. A first signal of a first energy modality is provided tothe surgical instrument between the terminals labeled ENERGY₁ andRETURN. A second signal of a second energy modality is coupled across acapacitor 910 and is provided to the surgical instrument between theterminals labeled ENERGY₂ and RETURN. It will be appreciated that morethan two energy modalities may be output and thus the subscript “n” maybe used to designate that up to n ENERGY_(n) terminals may be provided,where n is a positive integer greater than 1. It also will beappreciated that up to “n” return paths RETURN_(n) may be providedwithout departing from the scope of the present disclosure.

A first voltage sensing circuit 912 is coupled across the terminalslabeled ENERGY₁ and the RETURN path to measure the output voltagetherebetween. A second voltage sensing circuit 924 is coupled across theterminals labeled ENERGY₂ and the RETURN path to measure the outputvoltage therebetween. A current sensing circuit 914 is disposed inseries with the RETURN leg of the secondary side of the powertransformer 908 as shown to measure the output current for either energymodality. If different return paths are provided for each energymodality, then a separate current sensing circuit should be provided ineach return leg. The outputs of the first and second voltage sensingcircuits 912, 924 are provided to respective isolation transformers 928,922 and the output of the current sensing circuit 914 is provided toanother isolation transformer 916. The outputs of the isolationtransformers 916, 928, 922 on the primary side of the power transformer908 (non-patient isolated side) are provided to a one or more ADCcircuit 926. The digitized output of the ADC circuit 926 is provided tothe processor 902 for further processing and computation. The outputvoltages and output current feedback information can be employed toadjust the output voltage and current provided to the surgicalinstrument and to compute output impedance, among other parameters.Input/output communications between the processor 902 and patientisolated circuits is provided through an interface circuit 920. Sensorsalso may be in electrical communication with the processor 902 by way ofthe interface circuit 920.

In one aspect, the impedance may be determined by the processor 902 bydividing the output of either the first voltage sensing circuit 912coupled across the terminals labeled ENERGY₁/RETURN or the secondvoltage sensing circuit 924 coupled across the terminals labeledENERGY₂/RETURN by the output of the current sensing circuit 914 disposedin series with the RETURN leg of the secondary side of the powertransformer 908. The outputs of the first and second voltage sensingcircuits 912, 924 are provided to separate isolations transformers 928,922 and the output of the current sensing circuit 914 is provided toanother isolation transformer 916. The digitized voltage and currentsensing measurements from the ADC circuit 926 are provided the processor902 for computing impedance. As an example, the first energy modalityENERGY₁ may be RF monopolar energy and the second energy modalityENERGY₂ may be RF bipolar energy. Nevertheless, in addition to bipolarand monopolar RF energy modalities, other energy modalities includeultrasonic energy, irreversible and/or reversible electroporation and/ormicrowave energy, among others. Also, although the example illustratedin FIG. 1 shows a single return path RETURN may be provided for two ormore energy modalities, in other aspects, multiple return pathsRETURN_(n) may be provided for each energy modality ENERGY_(n).

As shown in FIG. 1, the generator 900 comprising at least one outputport can include a power transformer 908 with a single output and withmultiple taps to provide power in the form of one or more energymodalities, such as ultrasonic, bipolar or monopolar RF, irreversibleand/or reversible electroporation, and/or microwave energy, amongothers, for example, to the end effector depending on the type oftreatment of tissue being performed. For example, the generator 900 candeliver energy with higher voltage and lower current to drive anultrasonic transducer, with lower voltage and higher current to drive RFelectrodes for sealing tissue, or with a coagulation waveform for spotcoagulation using either monopolar or bipolar RF electrosurgicalelectrodes. The output waveform from the generator 900 can be steered,switched, or filtered to provide the frequency to the end effector ofthe surgical instrument. In one example, a connection of RF bipolarelectrodes to the generator 900 output would be preferably locatedbetween the output labeled ENERGY₂ and RETURN. In the case of monopolaroutput, the preferred connections would be active electrode (e.g.,pencil or other probe) to the ENERGY₂ output and a suitable return padconnected to the RETURN output.

Additional details are disclosed in U.S. Patent Application PublicationNo. 2017/0086914, titled TECHNIQUES FOR OPERATING GENERATOR FORDIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICALINSTRUMENTS, which published on Mar. 30, 2017, which is hereinincorporated by reference in its entirety.

FIG. 2 illustrates one form of a surgical system 1000 comprising agenerator 1100 and various surgical instruments 1104, 1106, 1108 usabletherewith, where the surgical instrument 1104 is an ultrasonic surgicalinstrument, the surgical instrument 1106 is an RF electrosurgicalinstrument, and the multifunction surgical instrument 1108 is acombination ultrasonic/RF electrosurgical instrument. The generator 1100is configurable for use with a variety of surgical instruments.According to various forms, the generator 1100 may be configurable foruse with different surgical instruments of different types including,for example, ultrasonic surgical instruments 1104, RF electrosurgicalinstruments 1106, and multifunction surgical instruments 1108 thatintegrate RF and ultrasonic energies delivered simultaneously from thegenerator 1100. Although in the form of FIG. 2 the generator 1100 isshown separate from the surgical instruments 1104, 1106, 1108 in oneform, the generator 1100 may be formed integrally with any of thesurgical instruments 1104, 1106, 1108 to form a unitary surgical system.The generator 1100 comprises an input device 1110 located on a frontpanel of the generator 1100 console. The input device 1110 may compriseany suitable device that generates signals suitable for programming theoperation of the generator 1100. The generator 1100 may be configuredfor wired or wireless communication.

The generator 1100 is configured to drive multiple surgical instruments1104, 1106, 1108. The first surgical instrument is an ultrasonicsurgical instrument 1104 and comprises a handpiece 1105 (HP), anultrasonic transducer 1120, a shaft 1126, and an end effector 1122. Theend effector 1122 comprises an ultrasonic blade 1128 acousticallycoupled to the ultrasonic transducer 1120 and a clamp arm 1140. Thehandpiece 1105 comprises a trigger 1143 to operate the clamp arm 1140and a combination of the toggle buttons 1137, 1134 b, 1134 c to energizeand drive the ultrasonic blade 1128 or other function. The togglebuttons 1137, 1134 b, 1134 c can be configured to energize theultrasonic transducer 1120 with the generator 1100.

The generator 1100 also is configured to drive a second surgicalinstrument 1106. The second surgical instrument 1106 is an RFelectrosurgical instrument and comprises a handpiece 1107 (HP), a shaft1127, and an end effector 1124. The end effector 1124 compriseselectrodes in clamp arms 1145, 1142 b and return through an electricalconductor portion of the shaft 1127. The electrodes are coupled to andenergized by a bipolar energy source within the generator 1100. Thehandpiece 1107 comprises a trigger 1145 to operate the clamp arms 1145,1142 b and an energy button 1135 to actuate an energy switch to energizethe electrodes in the end effector 1124. The second surgical instrument1106 can also be used with a return pad to deliver monopolar energy totissue.

The generator 1100 also is configured to drive a multifunction surgicalinstrument 1108. The multifunction surgical instrument 1108 comprises ahandpiece 1109 (HP), a shaft 1129, and an end effector 1125. The endeffector 1125 comprises an ultrasonic blade 1149 and a clamp arm 1146.The ultrasonic blade 1149 is acoustically coupled to the ultrasonictransducer 1120. The handpiece 1109 comprises a trigger 1147 to operatethe clamp arm 1146 and a combination of the toggle buttons 11310, 1137b, 1137 c to energize and drive the ultrasonic blade 1149 or otherfunction. The toggle buttons 11310, 1137 b, 1137 c can be configured toenergize the ultrasonic transducer 1120 with the generator 1100 andenergize the ultrasonic blade 1149 with a bipolar energy source alsocontained within the generator 1100. Monopolar energy can be deliveredto the tissue in combination with, or separately from, the bipolarenergy.

The generator 1100 is configurable for use with a variety of surgicalinstruments. According to various forms, the generator 1100 may beconfigurable for use with different surgical instruments of differenttypes including, for example, the ultrasonic surgical instrument 1104,the RF electrosurgical instrument 1106, and the multifunction surgicalinstrument 1108 that integrates RF and ultrasonic energies deliveredsimultaneously from the generator 1100. Although in the form of FIG. 2,the generator 1100 is shown separate from the surgical instruments 1104,1106, 1108, in another form the generator 1100 may be formed integrallywith any one of the surgical instruments 1104, 1106, 1108 to form aunitary surgical system. As discussed above, the generator 1100comprises an input device 1110 located on a front panel of the generator1100 console. The input device 1110 may comprise any suitable devicethat generates signals suitable for programming the operation of thegenerator 1100. The generator 1100 also may comprise one or more outputdevices 1112. Further aspects of generators for digitally generatingelectrical signal waveforms and surgical instruments are described in USpatent application publication US-2017-0086914-A1, which is hereinincorporated by reference in its entirety.

FIG. 3 illustrates a schematic diagram of a surgical instrument or tool600 comprising a plurality of motor assemblies that can be activated toperform various functions. In the illustrated example, a closure motorassembly 610 is operable to transition an end effector between an openconfiguration and a closed configuration, and an articulation motorassembly 620 is operable to articulate the end effector relative to ashaft assembly. In certain instances, the plurality of motors assembliescan be individually activated to cause firing, closure, and/orarticulation motions in the end effector. The firing, closure, and/orarticulation motions can be transmitted to the end effector through ashaft assembly, for example.

In certain instances, the closure motor assembly 610 includes a closuremotor. The closure 603 may be operably coupled to a closure motor driveassembly 612 which can be configured to transmit closure motions,generated by the motor to the end effector, in particular to displace aclosure member to close to transition the end effector to the closedconfiguration. The closure motions may cause the end effector totransition from an open configuration to a closed configuration tocapture tissue, for example. The end effector may be transitioned to anopen position by reversing the direction of the motor.

In certain instances, the articulation motor assembly 620 includes anarticulation motor that be operably coupled to an articulation driveassembly 622 which can be configured to transmit articulation motions,generated by the motor to the end effector. In certain instances, thearticulation motions may cause the end effector to articulate relativeto the shaft, for example.

One or more of the motors of the surgical instrument 600 may comprise atorque sensor to measure the output torque on the shaft of the motor.The force on an end effector may be sensed in any conventional manner,such as by force sensors on the outer sides of the jaws or by a torquesensor for the motor actuating the jaws.

In various instances, the motor assemblies 610, 620 include one or moremotor drivers that may comprise one or more H-Bridge FETs. The motordrivers may modulate the power transmitted from a power source 630 to amotor based on input from a microcontroller 640 (the “controller”), forexample, of a control circuit 601. In certain instances, themicrocontroller 640 can be employed to determine the current drawn bythe motor, for example.

In certain instances, the microcontroller 640 may include amicroprocessor 642 (the “processor”) and one or more non-transitorycomputer-readable mediums or memory units 644 (the “memory”). In certaininstances, the memory 644 may store various program instructions, whichwhen executed may cause the processor 642 to perform a plurality offunctions and/or calculations described herein. In certain instances,one or more of the memory units 644 may be coupled to the processor 642,for example. In various aspects, the microcontroller 640 may communicateover a wired or wireless channel, or combinations thereof.

In certain instances, the power source 630 can be employed to supplypower to the microcontroller 640, for example. In certain instances, thepower source 630 may comprise a battery (or “battery pack” or “powerpack”), such as a lithium-ion battery, for example. In certaininstances, the battery pack may be configured to be releasably mountedto a handle for supplying power to the surgical instrument 600. A numberof battery cells connected in series may be used as the power source630. In certain instances, the power source 630 may be replaceableand/or rechargeable, for example.

In various instances, the processor 642 may control a motor driver tocontrol the position, direction of rotation, and/or velocity of a motorof the assemblies 610, 620. In certain instances, the processor 642 cansignal the motor driver to stop and/or disable the motor. It should beunderstood that the term “processor” as used herein includes anysuitable microprocessor, microcontroller, or other basic computingdevice that incorporates the functions of a computer's centralprocessing unit (CPU) on an integrated circuit or, at most, a fewintegrated circuits. The processor 642 is a multipurpose, programmabledevice that accepts digital data as input, processes it according toinstructions stored in its memory, and provides results as output. It isan example of sequential digital logic, as it has internal memory.Processors operate on numbers and symbols represented in the binarynumeral system.

In one instance, the processor 642 may be any single-core or multicoreprocessor such as those known under the trade name ARM Cortex by TexasInstruments. In certain instances, the microcontroller 620 may be an LM4F230H5QR, available from Texas Instruments, for example. In at leastone example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4FProcessor Core comprising an on-chip memory of 256 KB single-cycle flashmemory, or other non-volatile memory, up to 40 MHz, a prefetch buffer toimprove performance above 40 MHz, a 32 KB single-cycle SRAM, an internalROM loaded with StellarisWare® software, a 2 KB EEPROM, one or more PWMmodules, one or more QEI analogs, one or more 12-bit ADCs with 12 analoginput channels, among other features that are readily available for theproduct datasheet. Other microcontrollers may be readily substituted foruse with the surgical instrument 600. Accordingly, the presentdisclosure should not be limited in this context.

In certain instances, the memory 644 may include program instructionsfor controlling each of the motors of the surgical instrument 600. Forexample, the memory 644 may include program instructions for controllingthe closure motor and the articulation motor. Such program instructionsmay cause the processor 642 to control the closure and articulationfunctions in accordance with inputs from algorithms or control programsof the surgical instrument 600.

In certain instances, one or more mechanisms and/or sensors such as, forexample, sensors 645 can be employed to alert the processor 642 to theprogram instructions that should be used in a particular setting. Forexample, the sensors 645 may alert the processor 642 to use the programinstructions associated with closing and articulating the end effector.In certain instances, the sensors 645 may comprise position sensorswhich can be employed to sense the position of a closure actuator, forexample. Accordingly, the processor 642 may use the program instructionsassociated with closing the end effector to activate the motor of theclosure drive assembly 620 if the processor 642 receives a signal fromthe sensors 630 indicative of actuation of the closure actuator.

In some examples, the motors may be brushless DC electric motors, andthe respective motor drive signals may comprise a PWM signal provided toone or more stator windings of the motors. Also, in some examples, themotor drivers may be omitted and the control circuit 601 may generatethe motor drive signals directly.

It is common practice during various laparoscopic surgical procedures toinsert a surgical end effector portion of a surgical instrument througha trocar that has been installed in the abdominal wall of a patient toaccess a surgical site located inside the patient's abdomen. In itssimplest form, a trocar is a pen-shaped instrument with a sharptriangular point at one end that is typically used inside a hollow tube,known as a cannula or sleeve, to create an opening into the body throughwhich surgical end effectors may be introduced. Such arrangement formsan access port into the body cavity through which surgical end effectorsmay be inserted. The inner diameter of the trocar's cannula necessarilylimits the size of the end effector and drive-supporting shaft of thesurgical instrument that may be inserted through the trocar.

Regardless of the specific type of surgical procedure being performed,once the surgical end effector has been inserted into the patientthrough the trocar cannula, it is often necessary to move the surgicalend effector relative to the shaft assembly that is positioned withinthe trocar cannula in order to properly position the surgical endeffector relative to the tissue or organ to be treated. This movement orpositioning of the surgical end effector relative to the portion of theshaft that remains within the trocar cannula is often referred to as“articulation” of the surgical end effector. A variety of articulationjoints have been developed to attach a surgical end effector to anassociated shaft in order to facilitate such articulation of thesurgical end effector. As one might expect, in many surgical procedures,it is desirable to employ a surgical end effector that has as large arange of articulation as possible.

Due to the size constraints imposed by the size of the trocar cannula,the articulation joint components must be sized so as to be freelyinsertable through the trocar cannula. These size constraints also limitthe size and composition of various drive members and components thatoperably interface with the motors and/or other control systems that aresupported in a housing that may be handheld or comprise a portion of alarger automated system. In many instances, these drive members mustoperably pass through the articulation joint to be operably coupled toor operably interface with the surgical end effector. For example, onesuch drive member is commonly employed to apply articulation controlmotions to the surgical end effector. During use, the articulation drivemember may be unactuated to position the surgical end effector in anunarticulated position to facilitate insertion of the surgical endeffector through the trocar and then be actuated to articulate thesurgical end effector to a desired position once the surgical endeffector has entered the patient.

Thus, the aforementioned size constraints form many challenges todeveloping an articulation system that can effectuate a desired range ofarticulation, yet accommodate a variety of different drive systems thatare necessary to operate various features of the surgical end effector.Further, once the surgical end effector has been positioned in a desiredarticulated position, the articulation system and articulation jointmust be able to retain the surgical end effector in that position duringthe actuation of the end effector and completion of the surgicalprocedure. Such articulation joint arrangements must also be able towithstand external forces that are experienced by the end effectorduring use.

Various modes of one or more surgical devices are often used throughouta particular surgical procedure. Communication pathways extendingbetween the surgical devices and a centralized surgical hub can promoteefficiency and increase success of the surgical procedure, for example.In various instances, each surgical device within a surgical systemcomprises a display, wherein the display communicates a presence and/oran operating status of other surgical devices within the surgicalsystem. The surgical hub can use the information received through thecommunication pathways to assess compatibility of the surgical devicesfor use with one another, assess compatibility of the surgical devicesfor use during a particular surgical procedure, and/or optimizeoperating parameters of the surgical devices. As described in greaterdetail herein, the operating parameters of the one or more surgicaldevices can be optimized based on patient demographics, a particularsurgical procedure, and/or detected environmental conditions such astissue thickness, for example.

FIGS. 4 and 5 illustrate an exploded view (FIG. 4) and a cross-sectionalview (FIG. 5) of an end effector 1200 of an electrosurgical instrument(e.g. surgical instruments described in U.S. Patent Application AttorneyDocket No. END9234USNP2/190717-2). For example, the end effector 1200can be, actuated, articulated, and/or rotated with respect to a shaftassembly of a surgical instrument in a similar manner to end effectorsdescribed in U.S. Patent Application Attorney Docket No.END9234USNP2/190717-2. Additionally, the end effectors 1200 and othersimilar end effectors, which are described elsewhere herein, can bepowered by one or more generators of a surgical system. Example surgicalsystems for use with the surgical instrument are described in U.S.application Ser. No. 16/562,123, filed Sep. 5, 2019, and titled METHODFOR CONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM WITHMULTIPLE DEVICES, which is hereby incorporated herein in its entirety.

Referring to FIGS. 6-8, the end effector 1200 includes a first jaw 1250and a second jaw 1270. At least one of the first jaw 1250 and the secondjaw 1270 is pivotable toward and away from the other jaw to transitionthe end effector 1200 between an open configuration and a closedconfiguration. The jaws 1250, 1270 are configured to grasp tissuetherebetween to apply at least one of a therapeutic energy and anon-therapeutic energy to the tissue. Energy delivery to the tissuegrasped by the jaws 1250, 1270 of the end effector 1200 is achieved byelectrodes 1252, 1272, 1274, which are configured to deliver the energyin a monopolar mode, bipolar mode, and/or a combination mode withalternating or blended bipolar and monopolar energies. The differentenergy modalities that can be delivered to the tissue by the endeffector 1200 are described in greater detail elsewhere in the presentdisclosure.

In addition to the electrodes 1252, 1272, 1274, a patient return pad isemployed with the application of monopolar energy. Furthermore, thebipolar and monopolar energies are delivered using electrically isolatedgenerators. During use, the patient return pad can detect unexpectedpower crossover by monitoring power transmission to the return pad viaone or more suitable sensors on the return pad. The unexpected powercrossover can occur where the bipolar and monopolar energy modalitiesare used simultaneously. In at least one example, the bipolar mode usesa higher current (e.g. 2-3 amp) than the monopolar mode (e.g. 1 amp). Inat least one example, the return pad includes a control circuit and atleast one sensor (e.g. current sensor) coupled thereto. In use, thecontrol circuit can receive an input indicative of an unexpected powercrossover based on measurements of the at least one sensor. In response,the control circuit may employ a feedback system to issue an alertand/or pause application of one or both of the bipolar and monopolarenergy modalities to tissue.

Further to the above, the jaws 1250, 1270 of the end effector 1200comprise angular profiles where a plurality of angles are definedbetween discrete portions of each of the jaws 1250, 1270. For example, afirst angle is defined by portions 1250 a, 1250 b (FIG. 4), and a secondangle is defined by portions 1250 b, 1250 c of the first jaw 1250.Similarly, a first angle is defined by portions 1270 a, 1270 b, and asecond angle is defined by portions 1270 b, 1270 c of the second jaw1270. In various aspects, the discrete portions of the jaws 1250, 1270are linear segments. Consecutive linear segments intersect at anglessuch as, for example, the first angle, or the second angle. The linearsegments cooperate to form a generally angular profile of each of thejaws 1250, 1270. The angular profile is general bent away from a centralaxis.

In one example, the first angles and the second angles are the same, orat least substantially the same. In another example, the first anglesand the second angles are different. In another example, the first angleand the second angle comprise values selected from a range of about 120°to about 175°. In yet another example, the first angle and the secondangle comprise values selected from a range of about 130° to about 170°.

Furthermore, the portions 1250 a, 1270 a, which are proximal portions,are larger than the portions 1250 b, 1270 b, which are intermediateportions. Similarly, the intermediate portions 1250 b, 1270 b are largerthan the portions 1250 c, 1270 c. In other examples, the distal portionscan be larger than the intermediate and/or proximal portions. In otherexamples, the intermediate portions are larger than the proximal and/ordistal portions.

Further to the above, the electrodes 1252, 1272, 1274 of the jaws 1250,1270 comprise angular profiles that are similar to the angular profilesof the jaws 1250, 1270. In the example of FIGS. 4, 5, the electrodes1252, 1272, 1274 include discrete segments 1252 a, 1252 b, 1252 c, 1272a, 1272 b, 1272 c, 1274 a, 1274 b, 1274 c, respectively, which definefirst and second angles at their respective intersections, as describedabove.

When in the closed configuration, the jaws 1250, 1270 cooperate todefine a tip electrode 1260 formed of electrode portions 1261, 1262 atthe distal ends of the jaws 1250, 1270, respectively. The tip electrode1260 can be energized to deliver monopolar energy to tissue in contacttherewith. Both of the electrode portions 1261, 1262 can be activatedsimultaneously to deliver the monopolar energy, as illustrated in FIG. 6or, alternatively, only one of the electrode portions 1261, 1262 can beselectively activated to deliver the monopolar energy on one side of thedistal tip electrode 1260, as illustrated in FIG. 10, for example.

The angular profiles of the jaws 1250, 1270 cause the tip electrode 1260to be on one side of a plane extending laterally between the proximalportion 1252 c and the proximal portion 1272 c in the closedconfiguration. The angular profiles may also cause the intersectionsbetween portions 1252 b, 1252 c, portions, 1272 b, 1272 c, and portions1274 b, 1274 c to be on the same side of the plane as the tip electrode1260.

In at least one example, the jaws 1250, 1270 include conductiveskeletons 1253, 1273, which can be comprised, or at least partiallycomprised, of a conductive material such as, for example, Titanium. Theskeletons 1253, 1273 can be comprised of other conductive materials suchas, for example, Aluminum. In at least one example, the skeletons 1253,1273 are prepared by injection molding. In various examples, theskeletons 1253, 1273 are selectively coated/covered with an insulativematerial to prevent thermal conduction and electrical conduction in allbut predefined thin energizable zones forming the electrodes 1252, 1272,1274, 1260. The skeletons 1253, 1273 act as electrodes with electronfocusing where the jaws 1250, 1270 have built-in isolation from one jawto the other. The insulative material can be an insulative polymer suchas, for example, PolyTetraFluoroEthylene (e.g. Teflon®). The energizablezones that are defined by the electrodes 1252, 1272 are on the inside ofthe jaws 1250, 1270, and are operable independently in a bipolar mode todeliver energy to tissue grasped between the jaws 1250, 1270. Meanwhile,the energizable zones that are defined by the electrode tip 1260 and theelectrode 1274 are on the outside of the jaws 1250, 1270, and areoperable to deliver energy to tissue adjacent an external surface of theend effector 1200 in a monopolar mode. Both of the jaws 1250, 1270 canbe energized to deliver the energy in the monopolar mode.

In various aspects, the coating 1264 is a high temperaturePolyTetraFluoroEthylene (e.g. Teflon®) coating that is selectivelyapplied to a conductive skeleton yielding selective exposed metallicinternal portions that define a three-dimensional geometric electronmodulation (GEM) for a focused dissection and coagulation. In at leastone example, the coating 1264 comprises a thickness of about 0.003inches, about 0.0035 inches, or about 0.0025 inches. In variousexamples, the thickness of the coating 1264 can be any value selectedfrom a range of about 0.002 inches to about 0.004 inches, a range ofabout 0.0025 inches to about 0.0035 inches, or a range of about 0.0027inches to about 0.0033 inches. Other thicknesses for the coating 1263that are capable of three-dimensional geometric electron modulation(GEM) are contemplated by the present disclosure.

The electrodes 1252, 1272, which cooperate to transmit bipolar energythrough the tissue, are offset to prevent circuit shorting. As energyflows between the offset electrodes 1252, 1272, the tissue-graspedtherebetween is heated generating a seal at the area between electrodes1252, 1272. Meanwhile, regions of the jaws 1250, 1270 surrounding theelectrodes 1252, 1272 provide non-conductive tissue contact surfacesowing to an insulative coating 1264 selectively deposited onto the jaws1250, 1270 on such regions but not the electrodes 1252, 1272.Accordingly, the electrodes 1252, 1272 are defined by regions of themetallic jaws 1250, 1270, which remain exposed following application ofthe insulative coating 1264 to the jaws 1250, 1270. While the jaws 1250,1270 are generally formed of electrically conductive material in thisexample, the non-conductive regions are defined by the electricallyinsulative coating 1264.

FIG. 6 illustrates an application of a bipolar energy mode to tissuegrasped between the jaws 1250, 1270. In the bipolar energy mode, RFenergy flows through the tissue along a path 1271 that is obliquerelative to a curved plane (CL) extending centrally, and longitudinallybisecting, the jaws 1250, 1270 such that the electrodes 1252, 1272 areon opposite sides of the curved plane (CL). In other words, the regionof tissue that actually receives bipolar RF energy will only be thetissue that is contacting and extending between the electrodes 1252,1257. Thus, the tissue grasped by the jaws 1250, 1270 will not receiveRF energy across the entire lateral width of jaws 1250, 1270. Thisconfiguration may thus minimize the thermal spread of heat caused by theapplication of bipolar RF energy to the tissue. Such minimization ofthermal spread may in turn minimize potential collateral damage totissue that is adjacent to the particular tissue region that the surgeonwishes to weld/seal/coagulate and/or cut.

In at least one example, a lateral gap is defined between the offsetelectrodes 1252, 1272 in a closed configuration without tissuetherebetween. In at least one example, the lateral gap is definedbetween the offset electrodes 1252, 1272 in the closed configuration byany distance selected from a range of about 0.01 inch to about 0.025inch, a range of about 0.015 inch to about 0.020 inch, or a range ofabout 0.016 inch to about 0.019 inch. In at least one example, thelateral gap is defined by a distance of about 0.017 inch.

In the example illustrated in FIGS. 4 and 5, the electrodes 1252, 1272,1274 comprise gradually narrowing widths as each of the electrodes 1252,1272, 1274 extends from a proximal end to a distal end. Consequently,the proximal segments 1252 a, 1272 a, 1274 a comprise surface areas thatare greater than the intermediate portions 1252 b, 1272 b, 1274 b,respectively. Also, the intermediate segments 1252 b, 1272 b, 1274 bcomprise surfaces that are greater than the distal segments 1252 c, 1272c, 1274 c.

The angular and narrowing profiles of the jaws 1250, 1270 gives the endeffector 1200 a bent finger-like shape or an angular hook shape in theclosed configuration. This shape permits accurate delivery of energy toa small portion of the tissue using the tip electrode 1260 (FIG. 10) byorienting the end effector 1200 such that the electrode tip 1260 ispointed down toward the tissue. In such orientation, only the electrodetip 1260 is in contact with the tissue, which focuses the energydelivery to the tissue.

Furthermore, as illustrated in FIG. 8, the electrode 1274 extends on anouter surface on a peripheral side 1275 of the second jaw 1270, whichaffords it the ability effectively separate tissue in contact therewithwhile the end effector 1200 is in the closed configuration. To separatethe tissue, the end effector 1200 is positioned, at least partially, onthe peripheral side 1275 that includes the electrode 1274. Activation ofthe monopolar energy mode through the jaw 1270 cause monopolar energy toflow through the electrode 1274 into the tissue in contact therewith.

FIGS. 9-11 illustrate an end effector 1200′ in use to deliver bipolarenergy to tissue through electrodes 1252′, 1272′ (FIG. 9) in a bipolarenergy mode of operation, to deliver monopolar energy to tissue throughthe electrode tip 1261 in a first monopolar mode of operation, and/or todeliver monopolar energy to tissue through the external electrode 1274in a second monopolar mode of operation. The end effector 1200′ issimilar in many respects to the end effector 1200. Accordingly, variousfeatures of the end effector 1200′ that are previously described withrespect to the end effector 1200 are not repeated herein in the samelevel of detail for brevity.

The electrodes 1252′, 1272′ are different from the electrodes 1252″,1272″ in that they define stepped, or uneven, tissue contacting surfaces1257, 1277. Electrically conductive skeletons 1253′, 1273′ of the jaws1250′, 1270′ include bulging, or protruding, portions that form theconductive tissue contacting surfaces of the electrodes 1252′, 1272′.The coating 1264 partially wraps around the bulging, or protrudingportions, that form the electrodes 1252′, 1272′, only leaving exposedthe conductive tissue contacting surfaces of the electrodes 1252′,1272′. Accordingly, in the example illustrated in FIG. 9, each of thetissue-contacting surfaces 1257, 1277 includes a step comprising aconductive tissue-contacting surface positioned between two insulativetissue-contacting surfaces that gradually descend the step. Said anotherway, each of the tissue-contacting surfaces 1257, 1277 includes a firstpartially conductive tissue-contacting surface and a second insulativetissue-contacting surface stepped down with respect to the firstpartially conductive tissue-contacting surface. Methods for forming theelectrodes 1252′, 1272′ are later described in connection with FIG. 12.

Furthermore, in a closed configuration without tissue therebetween, theoffset electrodes 1252′, 1272′ overlap defining a gap between opposinginsulative outer surfaces of the jaws 1250′, 1270′. Accordingly, thisconfiguration provides electrode surfaces that are both verticallyoffset from each other and laterally offset from each other when jaws1250′, 1270′ are closed. In one example, the gap is about 0.01 inch toabout 0.025 inch. In addition, while overlapping, the electrodes 1252′,1272′ are spaced apart by a lateral gap. To prevent circuit shorting,the lateral gap is less than or equal to a predetermined threshold. Inone example, the predetermined threshold is selected from a range of0.006 inch to 0.008 inch. In one example, the predetermined threshold isabout 0.006 inch.

Referring again to FIGS. 7, 10, the tip electrode 1260 is defined byuncoated electrode portions 1261, 1262 that are directly preceded byproximal coated portions that are circumferentially coated to allow fortip coagulation and otomy creation from either or both jaws 1250, 1270.In certain examples, the electrode portions 1261, 1262 are covered byspring-biased, or compliant, insulative housings that allow theelectrode portions 1261, 1262 to be exposed only when the distal end ofthe end effector 1200 is pressed against the tissue to be treated.

Additionally, the segments 1274 a, 1274 b, 1274 c define an angularprofile extending along the peripheral side 1275 of the jaw 1270. Thesegments 1274 a, 1274 b, 1274 c are defined by uncoated linear portionsprotruding from an angular body of the skeleton 1273 on the peripheralside 1275. The segments 1274 a, 1274 b, 1274 c comprise outer surfacesthat are flush with an outer surface of the coating 1264 defined on theperipheral side 1275. In various examples, a horizontal plane extendsthrough the segments 1274 a, 1274 b, 1274 c. The angular profile of theelectrode 1274 is defined in the horizontal plane such that theelectrode 1274 does not extend more than 45 degrees off a curvaturecenterline to prevent unintended lateral thermal damage while using theelectrode 1274 to dissect or separate tissue.

FIG. 14 illustrates a jaw 6270 for use with an end effector (e.g. 1200)of an electrosurgical instrument (e.g. electrosurgical instrument 1106)to treat tissue using RF energy. Further, the jaw 6270 is electricallycouplable to a generator (e.g. generator 1100), and is energizable bythe generator to deliver a monopolar RF energy to the tissue and/orcooperate with another jaw of the end effector to deliver a bipolar RFenergy to the tissue. In addition, the jaw 6270 is similar in manyrespects to the jaws 1250, 1270. For example, the jaw 6270 comprises anangular profile that is similar to the angular profile of the jaw 1270.In addition, the jaw 6270 presents a thermal mitigation improvement thatcan be applied to one or both of the jaws 1250, 1270.

In use, jaws of an end effector of an electrosurgical instrument aresubjected to a thermal load that can interfere with the performance oftheir electrode(s). To minimize the thermal load interference withoutnegatively affecting the electrode(s) tissue treatment capabilities, thejaw 6270 includes an electrically conductive skeleton 6273 that has athermally insulative portion and a thermally conductive portion integralwith the thermally insulative portion. The thermally conductive portiondefines a heat sink and the thermally insulative portion resists heattransfer. In certain examples, the thermally insulative portion includesinner gaps, voids, or pockets that effectively isolate the thermal massof the outer surfaces of the jaw 6270 that are directly in contact withthe tissue without compromising the electrical conductivity of the jaw6270.

In the illustrated example, the thermally conductive portion defines aconductive outer layer 6269 that surrounds, or at least partiallysurrounds, an inner conductive core. In at least one example, the innerconductive core comprises gap-setting members, which can be in the formof pillars, columns, and/or walls extending between opposite sides ofthe outer layer 6269 with gaps, voids, or pockets extending between thegap setting members.

In at least one example, the gap-setting members form honeycomb-likelattice structures 6267 to provide directional force capabilities as thejaws (i.e. the jaw 6270 and another jaw of the end effector) aretransitioned into a closed configuration to grasp tissue therebetween(similar to the jaws 1250, 1270 of FIG. 6). The directional force can beaccomplished by aligning the lattices 6267 in a direction thatintersects the tissue-contacting surface of the jaw 6270 such that theirhoneycomb walls 6268 are positioned perpendicularly with respect to thetissue-contacting surface.

Alternatively, or additionally, the conductive inner core of jaw 6270may include micro pockets of air, which could be more homogeneouslydistributed and shaped with no predefined organization relative toexterior shape of the jaw to create a more homogeneous stress-straindistribution within the jaw. In various aspects, the electricallyconductive skeleton 6273 can be prepared by three-dimensional printing,and may include three dimensionally printed interior pockets thatproduce electrically conductive but proportionally thermally insulatedcores.

Referring still to FIG. 14, the electrically conductive skeleton 6273 isconnectable to an energy source (e.g. generator 1100), and compriseselectrodes 6262, 6272, and 6274 that are defined on portions of theouter layer 6273 that are selectively not covered by the coating 1264.Accordingly, the jaw 6270 selective thermal and electrical conductivitythat controls/focuses energy interaction with tissue through theelectrodes 6272, 6274, while reducing thermal spread and thermal mass.The thermally insulated portions of the conductive skeleton 6273 limitthe thermal load on the electrodes 6262, 6272, and 6274 during use.

Furthermore, the outer layer 6273 defines gripping features 6277 thatextend on opposite sides of the electrode 6272, and are at leastpartially covered by the coating 1264. The gripping features 6277improve the ability of the jaw 6270 to adhere to tissue, and resisttissue slippage with respect to the jaw 6270.

In the illustrated examples, the walls 6268 extend diagonally from afirst lateral side of the jaw 6270 to a second lateral side of the jaw6270. The walls 6268 intersect at structural nodes. In the illustratedexample, intersecting walls 6268 define pockets 6271 that are coveredfrom the top and/or bottom by the outer layer 6269. Various methods formanufacturing the jaw 6270 are described below.

FIGS. 12, 13 illustrate methods 1280, 1281 for manufacturing jaws 1273″,1273′″. In various examples, one more of the jaws 1250, 1270, 1250′,1270′ are manufactured in accordance with the methods 1280, 1281. Thejaws 1273″, 1273′″ are prepared by applying a coating 1264 (e.g. with athickness d) to their entire external surfaces. Then, electrodes aredefined by selectively removing portions of the coating 1264 fromdesired zones to expose the external surface of the skeletons 1273″,1273′″ at such zones. In at least one example, selective removal of thecoating can be performed by etching (FIG. 12) or by partially cuttingaway (FIG. 13) tapered portions of the skeleton 1273′″ along with theirrespective coating portions to form flush conductive and non-conductivesurfaces. In the example illustrated FIG. 12, electrodes 1272″, 1274″are formed by etching. In the example illustrated FIG. 13, an electrode1274′″ is formed from a raised narrow band or ridge 1274 d extendingalongside the skeleton 1273′″. A portion of the ridge 1274D and thecoating 1264, directly covering the ridge 1274D, are cut away yieldingan external surface of the electrode 1274′″ that is flush with anexternal surface of the coating 1264.

Accordingly, a jaw 1270′″ manufactured by the method 1281 includes atapered electrode 1274′″ that is comprised of narrow raised electricallyconductive portion 1274 e extending alongside the skeleton 1273′″, whichcan help focus the energy delivered from the skeleton 1273′″ to thetissue, wherein the portion 1274 e has a conductive external surfacethat is flush with the coating 1264.

In another manufacturing process 6200, the jaw 6270 can be prepared asdepicted in FIG. 15. The electrically conductive skeleton 6273 is formedwith narrow raised bands or ridges 6274 e, 6274 f that define theelectrodes 6272, and 6274. In the illustrated example, the skeleton 6273of the jaw 6270 includes ridges 6274 e, 6274 f, with flat, or at leastsubstantially flat, outer surfaces that are configured to define theelectrodes 6272, 6274. In at least one example, the skeleton 6273 isprepared by 3D printing. Masks 6265, 6266 are applied to the ridges 6274e, 6274 f, and a coating 1264, which is similar to the coating 1264, isapplied to the skeleton 6273. After coating, the masks 6265, 6266 areremoved exposing outer surfaces of the electrodes 6272, 6274 that areflush with the outer surface of the coating 1264.

Referring to FIGS. 14 and 15, in various examples, the outer layer 6269comprises gripping features 6277 extending laterally on one or bothsides of each of the electrode 6272. The gripping features 6277 arecovered by the coating 1264. In one example, the coating 1264 definescompressible features causing the gap between the jaws of an endeffector to vary depending on clamping loads applied to the end effector1200. In at least one example, the coating 1264 on the jaws yields atleast a 0.010″-0.020″ overlap of insulation along the centerline of thejaws. The coating 1264 could be applied directly over the grippingfeatures 6277 and/or clamp induced jaw re-alignment features.

In various aspects, the coating 1264 may comprise coating materials suchas Titanium Nitride, Diamond-Like coating (DLC), Chromium Nitride,Graphit iC™, etc. In at least one example, the DLC is comprised of anamorphous carbon-hydrogen network with graphite and diamond bondingsbetween the carbon atoms. The DLC coating 1264 can form films with lowfriction and high hardness characteristics around the skeletons 1253,1273 (FIG. 6). The DLC coating 1264 can be doped or undoped, and isgenerally in the form of amorphous carbon (a-C) or hydrogenatedamorphous carbon (a-C:H) containing a large fraction of sp3 bonds.Various surface coating technologies can be utilized to form the DLCcoating 1264 such as the surface coating technologies developed byOerlikon Balzers. In at least one example, the DLC coating 1264 isgenerated using Plasma-assisted Chemical Vapor Deposition (PACVD).

Referring still to FIG. 15, in use, electrical energy flows from theelectrically conductive skeleton 6269 to tissue through the electrode6272. The coating 1264 prevents transfer of the electrical energy to thetissue from other regions of the outer layer 6269 that are covered withthe coating 1264. As the surface of the electrode 6272 increases intemperature during a tissue treatment, the thermal energy transfer fromthe outer layer 6269 to the inner core of the skeleton 6273 is sloweddown, or dampened, due to the gaps, voids, or pockets defined by thewalls 6268 of the inner core.

FIG. 16 illustrates a skeleton 6290 manufactured for use with a jaw ofan end effector of an electrosurgical instrument. One more of theskeletons 1253, 1273, 1253′, 1273′, 1273″, 1273′″ can comprise amaterial composition and/or can be manufactured in a similar manner tothe skeleton 6290. In the illustrated example, the skeleton 6290 iscomprised of at least two materials: an electrically conductive materialsuch as, for example, Titanium, and a thermally insulative material suchas, for example, a ceramic material (e.g. Ceramic Oxide). The Titaniumand Ceramic Oxide combination yields jaw components with compositethermal, mechanical, and electrical properties.

In the illustrated example, the composite skeleton 6290 comprises aceramic base 6291 formed by three-dimensional printing, for example.Additionally, the composite skeleton 6290 includes a titanium crown 6292prepared separately from the ceramic base 6291 using, for example,three-dimensional printing. The base 6291 and the crown 6292 includecomplementing attachment features 6294. In the illustrated example, thebase 6291 includes posts or projections that are received incorresponding apertures of the crown 6292. The attachment features 6294also control shrinking. Additionally, or alternatively, contactingsurfaces of the base 6291 and the crown 6292 include complementingsurface irregularities 6296 specifically design for a mating engagementwith one another. The surface irregularities 6296 also resist shrinkingcaused by the different material compositions of the base 6291 and thecrown 6292. In various examples, the composite skeleton 6290 isselectively coated with an insulative coating 1264 leaving exposedcertain portions of the crown 6292, which define electrodes, asdescribed above in connection with the jaws 1250, 1270, for example.

FIGS. 17 and 18 illustrate a manufacturing process for making a skeleton6296 for use with a jaw of an end effector of an electrosurgicalinstrument. One more of the skeletons 1253, 1273, 1253′, 1273′, 1273″,1273′″ can comprise a material composition and/or can be manufactured ina similar manner to the skeleton 6295. In the illustrated example, thecomposite skeleton 6295 is produced by injection molding utilizing aceramic powder 6297 and a titanium powder 6298. The powders are fusedtogether (FIG. 18) to form the titanium-ceramic composite 6299 (FIG.19). In at least one example, a PolyTetraFluoroEthylene (e.g. Teflon®)coating can be selectively applied to the metallic regions of thecomposite skeleton 6295 for thermal insulation as well as electricalinsulation.

FIGS. 20-22 illustrate a jaw 1290 for use with an end effector (e.g.1200) of an electrosurgical instrument (e.g. electrosurgical instrument1106) to treat tissue using RF energy. Further, the jaw 6270 iselectrically couplable to a generator (e.g. generator 1100), and isenergizable by the generator to deliver a monopolar RF energy to thetissue and/or cooperate with another jaw of the end effector to delivera bipolar RF energy to the tissue. In addition, the jaw 1290 is similarin many respects to the jaws 1250, 1270. For example, the jaw 1290comprises an angular profile that is similar to the angular or curvedprofile of the jaw 1270.

In addition, the jaw 1290 is similar to the jaw 6270 in that the jaw1290 also presents a thermal mitigation improvement. Like the jaw 6270,the jaw 1290 includes a conductive skeleton 1293 that has a thermallyinsulative portion and a thermally conductive portion integral with, orattached to, the thermally insulative portion. The thermally conductiveportion defines a heat sink and the thermally insulative portion resistsheat transfer. In certain examples, the thermally insulative portion ofthe conductive skeleton 1293 comprises a conductive inner core 1297 withinner gaps, voids, or pockets that effectively isolate the thermal massof the outer surface of the jaw 1290, which defines an electrode 1294that is directly in contact with the tissue, without compromising theelectrical conductivity of the jaw 1290. The thermally conductiveportions define a conductive outer layer 1303 that surrounds, or atleast partially surrounds, the conductive inner core 1297. In at leastone example, the conductive inner core 1297 comprises gap-settingmembers 1299, which can be in the form of pillars, columns, and/or wallsextending between opposite sides of the outer layer 1303 of the jaw 1290with gaps, voids, or pockets extending between the gap setting members.

Alternatively, or additionally, the conductive inner core 1297 mayinclude micro pockets of air, which could be homogeneously, ornon-homogenously, distributed in the conductive inner core 1297. Thepockets can comprise predefined, or random shapes, and can be dispersedat predetermined, or random, portions of the conductive inner core 1297.In at least one example, the pockets are dispersed in a manner thatcreates a more homogeneous stress-strain distribution within the jaw1290. In various aspects, the skeleton 1293 can be prepared bythree-dimensional printing, and may include three dimensionally printedinterior pockets that produce electrically conductive but proportionallythermally insulated cores.

Accordingly, the jaw 1290 comprises selective thermal and electricalconductivity that controls/focuses the energy interaction with tissue,while reducing thermal spread and thermal mass. The thermally insulatedportions of the conductive skeleton 1293 limit the thermal load on theelectrodes of the jaw 1290 during use.

FIG. 22 illustrates an expanded portion of a tissue-contacting surface1291 of the jaw 1290. In various aspects, the outer layer 1303 of theskeleton 1293 is selectively coated/covered with a first insulativelayer 1264 comprising a first material such as, for example, DLC. In theillustrated example, the DLC coating causes the tissue-contactingsurface 1291 to be electrically insulated except an intermediate areaextending along a length of the tissue-contacting surface 1291, whichdefines the electrode 1294. In at least one example, the DLC coatingextends around the skeleton 1293 covering the jaw 1290 up to perimetersdefined on opposite sides 1294′, 1294″ of the electrode 1294. Conductivezones 1294 a, 1294 b, 1294 c remain exposed, and alternate withinsulative zones 1298 along a length of the electrode 1294. In variousaspects, the insulative zones 1298 comprise a high temperaturePolyTetraFluoroEthylene (e.g. Teflon®). Since the DLC coating isthermally conductive, only the portions of the tissue-contacting surface1291 that comprise the insulative regions 1298 are thermally insulated.The portions of the issue-contacting surface 1291 that are covered withthe DLC coating and the thin conductive energizable zones 1294 a, 1294b, 1294 c are thermally conductive. Further, only the thin conductiveenergizable zones 1294 a, 1294 b, 1294 c are electrically conductive.The remaining portions of the tissue-contacting surface 1291, which arecovered with either the DLC coating or the PolyTetraFluoroEthylene (e.g.Teflon®), are electrically insulated.

The conductive zones 1294 a, 1294 b, 1294 c define energy concentrationlocations along the jaw 1290 based on the geometry of the zones 1294 a,1294 b, 1294 c. Further, the size, shape, and arrangement of theconductive zones 1294 a, 1294 b, 1294 c and insulative zones 1298 causescoagulation energy transmitted through the electrode 1294 to be directedinto the tissue in predefined treatment regions thereby preventingparasitic leaching of both the energy and heat from the treatmentregions. Furthermore, the thermally insulative conductive inner core1297 resists heat transfer to portions of the jaw 1290 that do not formtreatment regions, which prevents inadvertent collateral thermal damageby incidental contact of tissue with non-treatment areas of the jaw1290.

The electrode 1294 is selectively interrupted by the regions 1298.Selective application of the high temperature PolyTetraFluoroEthylene(e.g. Teflon®) coating to portions of the electrode 1294 yieldsselectively exposed metallic internal portions that define athree-dimensional geometric electron modulation (GEM) for a focuseddissection and coagulation at the conductive zones 1294 a, 1294 b, 1294c of the electrode 1294. The regions 1298 are selectively deposited ontothe electrode 1294, as illustrated in FIG. 22, yielding a treatmentsurface with alternating thermally and electrically conductive regionsand thermally and electrically insulative regions surrounded by athermally conductive but electrically insulative outer perimeter regiondefined by the DLC coating.

Referring to FIG. 22, the jaw 1290 comprises an angular profile where aplurality of angles are defined between discrete portions 1290 a, 1290b, 1290 c, 1290 d of the jaw 1290. For example, a first angle (α1) isdefined by portions 1290 a, 1290 b, a second angle (α2) is defined byportions 1290 b, 1290 c, and a third angle (α3) is defined by portions1290 c, 1290 d of the first jaw 1250. In other examples, at least aportion of a jaw 1290 comprises a smooth curved profile with no angles.In various aspects, the discrete portions 1290 a, 1290 b, 1290 c, 1290 dof the jaw 1290 are linear segments. Consecutive linear segmentsintersect at angles such as, for example, the first angle (α1), or thesecond angle (α2), and the third angle (α3). The linear segmentscooperate to form a generally curved profile of each of the jaw 1290.

In one example, the angles (α1, α2, α3) comprise the same, or at leastsubstantially the same, values. In another example, at least two of theangles (α1, α2, α3) comprise different values. In another example, atleast one of the angles (α1, α2, α3) comprises a value selected from arange of about 120° to about 175°. In yet another example, at least oneof the angles (α1, α2, α3) comprises a value selected from a range ofabout 130° to about 170°.

Furthermore, due to the gradually narrowing profile of the jaw 1290, theportion 1290 a, which is a proximal portion, is larger than the portion1290 b, which is an intermediate portion. Similarly, the intermediateportion 1290 b is larger than the portion 1290 d that defines a distalportion of the jaw 1290. In other examples, the distal portion can belarger than the intermediate and/or proximal portions. In otherexamples, the intermediate portion is larger than the proximal and/ordistal portions. In addition, the electrode 1294 of the jaw 1290comprises an angular profile that is similar to the angular profile ofthe jaw 1290.

Referring to FIG. 23, in certain aspects, a jaw 1300 includes a solidconductive skeleton 1301 that is partially surrounded by a DLC coating1264. The exposed regions of the skeleton 1301 define one or moreelectrodes 1302. This arrangement yields a thermally conductive andelectrically conductive portion of the jaw 1300, wherein the thermalenergy is delivered indiscriminately, but the electrical energy isexclusively delivered through the one or more electrodes 1302.

Referring now to FIGS. 24-26, an electrosurgical instrument 1500includes an end effector 1400 configured to deliver monopolar energyand/or bipolar energy to tissue grasped by the end effector 1400, asdescribed in greater detail below. The end effector 1400 is similar inmany respects to the end effector 1200. For example, the end effector1400 includes a first jaw 1450 and a second jaw 1470. At least one ofthe first jaw 1450 and the second jaw 1470 is movable relative to theother jaw to transition the end effector 1400 from an open configurationto a closed configuration to grasp the tissue therebetween. The graspedtissue can then be sealed and/or cut using monopolar and bipolarenergies. As described below in greater details, the end effector 1400utilizes GEM to adjust energy densities at a tissue treatment interfaceof the jaws 1450, 1470 to effect a desired tissue treatment.

Like the jaws 1250, 1270, the jaws 1450, 1470 include generally angularprofiles formed from linear portions that are angled with respect to oneanother, yielding a bent or finger-like shape, as illustrated in FIG.26. Furthermore, the jaws 1450, 1470 include conductive skeletons 1452,1472 that have narrowing angular bodies extending distally along theangular profile of the jaws 1450, 1470. The conductive skeletons 1452,1472 can be comprised of a conductive material such as, for example,Titanium. In certain aspects, each of the conductive skeletons 1453,1473 comprise a thermally insulative portion and a thermally conductiveportion integral with the thermally insulative portion. The thermallyconductive portion defines a heat sink and the thermally insulativeportion resists heat transfer. In certain examples, the thermallyinsulative portions of the skeletons 1453, 1473 define inner corescomprising inner gaps, voids, or pockets that effectively isolate thethermal mass of the outer surfaces of the jaws 1452, 1472 that aredirectly in contact with the tissue without compromising the electricalconductivity of the jaws 1450, 1470.

The thermally conductive portions comprise conductive outer layers 1469,1469′ that surround, or at least partially surround, the innerconductive cores. In at least one example, the inner conductive corescomprise gap-setting members, which can be in the form of pillars,columns, and/or walls extending between opposite sides of the outerlayers 1469, 1469′ of each of the jaws 1250, 1270 with gaps, voids, orpockets extending between the gap setting members. In at least oneexample, the gap-setting members form honeycomb-like lattice structures1467, 1467′.

Further to the above, the conductive skeletons 1453, 1473 include firstconductive portions 1453 a, 1473 a extending distally along the angularprofile of the jaws 1450, 1470 and second conductive portions 1453 b,1473 b defining a tapered electrodes protruding from the firstconductive portions 1453 a, 1473 a and extending distally along at leasta portion of the gradually narrowing body of the skeletons 1453, 1473.In at least on example, the first conductive portions 1453 a, 1473 a arethicker than the second conductive portions 1453 b, 1473 b in atransverse cross-section (e.g. FIG. 25) of the gradually narrowingbodies of the skeletons 1453, 1473. In at least one example, the secondconductive portions 1453 b, 1473 b are integral with, or permanentlyattached to, the first conductive portions 1453 a, 1473 a such thatelectrical energy flows from the first conductive portions 1453 a, 1473a to the tissue only through the second conductive portions 1453 b, 1473b. Electrically insulative layers 1464, 1464′ are configured tocompletely electrically insulate the first conductive portions 1453 a,1473 a but not the second conductive portions 1453 b, 1473 b. At leastouter surfaces of the second conductive portions 1453 b, 1473 b, whichdefine electrodes 1452, 1472, are not covered by the electricallyinsulative layers 1464, 1464′. In the illustrated example, theelectrodes 1452, 1472 and the electrically insulative layers 1464, 1464′define flush tissue treatment surfaces.

As described above, the first conductive portions 1453 a, 1473 a aregenerally thicker than the second conductive portions 1453 b, 1473 b,and are wrapped with the electrically insulative layers 1464, 1464′,which causes the second conductive portions 1453 b, 1473 b to becomehigh energy density areas. In at least one example, the electricallyinsulative layers 1464, 1464′ are comprised of high temperaturePolyTetraFluoroEthylene (e.g. Teflon®) coatings, DLC coatings, and/orceramic coatings for insulation and resistance to char sticking. Invarious examples, the thicker first conductive portion 1453 a conductsmore potential power with a smaller resistance to the tissue-contactingsecond conductive portion 1453 b yielding the higher energy density atthe electrode 1452.

In various aspects, the outer surfaces of the electrodes 1452, 1472include consecutive linear segments that extend along angled tissuetreatment surfaces of the jaws 1450, 1470. The linear segments intersectat predefined angles, and comprise widths that gradually narrow as thelinear segments extend distally. In the example illustrated in FIG. 24,the electrode 1452 includes segments 1452 a, 1452 b, 1452 c, 1452 c,1452 d, and the electrode 1472 includes segments 1472 a, 1472 b, 1472 c,1472 c, 1472 d. The electrode 1452 of the jaw 1450 is illustrated bydashed lines on the jaw 1470 of FIG. 24 to show the lateral position ofthe electrode 1452 with respect to the electrode 1452 in a closedconfiguration of the end effector 1400. The electrodes 1452, 1472 arelaterally offset from one another in the closed configuration. In abipolar energy mode, the electrical energy supplied by the generator(e.g. generator 1100) flows from the first conductive portion 1453 a tothe electrode 1452 of the second conductive portion 1453 b, and from theelectrode 1452 to the tissue grasped between the jaws 1450, 1470. Thebipolar energy then flows from the tissue to the electrode 1472 of thesecond conductive portion 1473 b, and from the electrode 1472 to thefirst conductive portion 1473 a.

In various aspects, as illustrated in FIGS. 24, 25, the second jaw 1470further includes an electrode 1474 spaced apart from the skeleton 1473.In at least one example, the electrode 1474 is a monopolar electrodeconfigured to deliver monopolar energy to the tissue grasped between thejaws 1450, 1470 in the closed configuration. A return pad can be placedunder the patient, for example, to receive the monopolar energy from thepatient. Like the electrode 1472, the electrode 1474 includesconsecutive linear segments 1474 a, 1474 b, 1474 c, 1474 d that extenddistally along the angular profile defined by the second jaw 1470 froman electrode proximal end to an electrode distal end. Further, theelectrode 1474 is laterally offset from the electrodes 1472, 1452.

The electrode 1474 includes a base 1474 e positioned in a cradle 1480extending distally along the angular profile of the second jaw 1470 froma cradle proximal 1480 a and to a cradle distal end 1480 b. The cradle1480 is centrally situated with respect to lateral edges 1470 e, 1470 fof the second jaw 1470. The electrode 1474 further comprises a taperededge 1474 f extending from the base 1474 e beyond sidewalls of thecradle 1480. In addition, the cradle 1480 is partially embedded in avalley defined in an outer tissue-treatment surface of the narrowingcurved body. The cradle 1480 is spaced apart from the graduallynarrowing body of the skeleton 1473 by the electrically insulativecoating 1464′. As illustrated in FIG. 24, the base 1480 comprises widthsthat gradually narrow as the base extends along the angular profile froma base proximal end 1480 a to a base distal end 1480 b.

In various examples, the cradle 1480 is comprised of a compliantsubstrate. In an uncompressed state, as illustrated in FIG. 25, thesidewalls of the cradle 1480 extend beyond a tissue treatment surface ofthe jaw 1472. When tissue is compressed between the jaws 1450, 1470, thecompressed tissue applies a biasing force against the sidewalls of thecradle 1480 further exposing the tapered edge 1474 f of the electrode1474.

One or more of the jaws described by the present disclosure include stopmembers or gap-setting members, which are features extending outwardlyfrom one or both of the tissue treatment surfaces of the jaws of an endeffector. The stop members help maintain a separation or a predeterminedgap between the jaws in a closed configuration with no tissue betweenthe jaws. In at least one example, the sidewalls of the cradle 1480define such stop members. In another example, the stop members can be inthe form of insulative pillars or laterally extending spring-biasedfeatures that allow the gap between opposing jaws and the closedconfiguration to vary based on clamping loads.

Most electrosurgery generators use constant power modes. With constantpower modes, the power output remains constant as impedance increases.In constant power modes, the voltage increases as the impedanceincreases. Increased voltage causes thermal damage to tissue. GEMfocuses the energy output of the jaws 1250, 1270, for example, bycontrolling the size and shape of the electrodes 1252, 1272, 1274, 1260,1294, 1472, 1452, 1474, as described above, and modulating the powerlevel based on tissue impedance to create a low voltage plasma.

In certain instances, GEM maintains a constant minimum voltage requiredfor cutting at the surgical site. The generator (e.g. 1100) modulatesthe power in order to maintain the voltage as close as possible to theminimum voltage required for cutting at the surgical site. In order toobtain an arc plasma and cut, current is pushed by voltage fromgradually narrowing portions of the electrodes 1252, 1272, 1274, 1260,1294, 1472, 1452, 1474, to the tissue. In certain examples, a minimumvoltage of approximately 200 Volts is maintained. Cutting with greaterthan 200 Volts increases thermal damage and cutting with less than 200Volts results in minimal arcing and drag in the tissue. Accordingly, thegenerator (e.g. 1100) modulates the power to ensure utilizing theminimum voltage possible that will still form an arc plasma and cut.

Referring primarily to FIG. 26, a surgical instrument 1500 includes theend effector 1400. The surgical instrument 1500 is similar in manyrespects to other surgical instruments described in U.S. PatentApplication Attorney Docket No. END9234USNP2/190717-2. Various actuationand articulation mechanisms described elsewhere in connection with suchsurgical instruments could be similarly utilized to articulate and/oractuate the surgical instrument 1500. For brevity, such mechanisms arenot repeated herein.

The end effector 1400 comprises an end effector frame assembly 11210that comprises a distal frame member 11220 that is rotatably supportedin a proximal frame housing 11230. In the illustrated example, thedistal frame member 11220 is rotatably attached to the proximal framehousing 11230 by an annular rib on the distal frame member 11220 that isreceived within an annular groove in the proximal frame housing 11230.

Electrical energy is transmitted to the electrodes 1452, 1472, 1474 ofthe end effector 1400 by one or more flex circuits extending distallythrough, or alongside, the distal frame member 11220. In the illustratedexample, a flex circuit 1490 is fixedly attached to the first jaw 1450.More particularly, the flex circuit 1490 includes a distal portion 1492that can be fixedly attached to an exposed portion 1491 of the first jaw1450, which is not covered by the insulative layer 1464.

A slip ring assembly 1550 within the proximal frame housing 11230 allowsfree rotation of the end effector 1400 about a shaft of the surgicalinstrument 1500 without entanglement of the wires of the circuitstransmitting electrical energy to the electrodes 1452, 1472, 1474. Inthe illustrated example, the flex circuit 1490 includes an electricalcontact 1493 in movable engagement with a slip ring 1550 a of the slipring assembly 1550. Electrical energy is transmitted from the slip ring1550 a to the conductive skeleton 1453, and then to the electrode 1452,through the flex circuit 1490. Since the electrical contact 1493 is notfixedly attached to the slip ring 1550 a, the rotation of the endeffector 1400 about the shaft of the surgical instrument 1500 ispermissible without losing the electrical connection between theelectrical contact 1493 and the slip ring 1550 a. Further, a similarelectrical contact transmits the electrical energy to the slip ring 1550a.

In the example illustrated in FIG. 26, the slip ring 1550 a isconfigured to transmit bipolar energy to the electrode 1452 of the jaw1450. A slip ring 1550 b cooperates with similar electrical contacts andthe electrode 1472 to define a return path for the bipolar energy. Inaddition, a slip ring 1550 c cooperates with similar electrical contactsand the electrode 1474 to provide a pathway for monopolar electricalenergy into tissue. The bipolar and monopolar electrical energies can bedelivered to the slip rings 1550 a, 1550 b through one or moreelectrical generators (e.g. generator 1100). The bipolar and monopolarelectrical energies can be delivered simultaneously or separately, asdescribed in greater detail elsewhere herein.

In various examples, the slip rings 1550 a, 1550 b, 1550 c areintegrated electrical slip rings with mechanical features 1556 a, 1556b, 1556 c configured to couple the slip rings 1550 a, 1550 b, 1550 c toan insulative support structure 1557, or a conductive support structurecoated with an insulative material, as illustrated in FIG. 26.Furthermore, the slip rings 1550 a, 1550 b, 1550 c are sufficientlyspaced apart to ensure that circuit shorting will not occur if aconductive fluid fills the space between the slip rings 1550 a, 1550 b,1550 c. In at least one example, a core flat stamped metallic shaftmember includes a three dimensionally printed, or over-molded,nonconductive portion for supporting the slip ring assembly 1550.

FIG. 27 illustrates a portion of an electrosurgical instrument 12000that comprises a surgical end effector 12200 that may be coupled to aproximal shaft segment by an articulation joint in the various suitablemanners. In certain instances, the surgical end effector 12200 comprisesan end effector frame assembly 12210 that comprises a distal framemember 12220 that is rotatably supported in a proximal frame housingthat is attached to the articulation joint.

The surgical end effector 12200 comprises a first jaw 12250 and a secondjaw 12270. In the illustrated example, the first jaw 12250 is pivotallypinned to the distal frame member 12220 for selective pivotal travelrelative thereto about a first jaw axis FJA defined by a first jaw pin12221. The second jaw 12270 is pivotally pinned to the first jaw 12250for selective pivotal travel relative to the first jaw 12250 about asecond jaw axis SJA that is defined by a second jaw pin 12272. In theillustrated example, the surgical end effector 12200 employs an actuatoryoke assembly 12610 that is pivotally coupled to the second jaw 12270 bya second jaw attachment pin 12273 for pivotal travel about a jawactuation axis JAA that is proximal and parallel to the first jaw axisFJA and the second jaw axis SJA. The actuator yoke assembly 12610comprises a proximal threaded drive shaft 12614 that is threadablyreceived in a threaded bore 12632 in a distal lock plate 12630. Thethreaded drive shaft 12614 is mounted to the actuator yoke assembly12610 for relative rotation therebetween. The distal lock plate 12630 issupported for rotational travel within the distal frame member 12220.Thus rotation of the distal lock plate 12630 will result in the axialtravel of the actuator yoke assembly 12610.

In certain instances, the distal lock plate 12630 comprises a portion ofan end effector locking system 12225. The end effector locking system12225 further comprises a dual-acting rotary lock head 12640 that isattached to a rotary drive shaft 12602 of the various types disclosedherein. The lock head 12640 comprises a first plurality of radiallyarranged distal lock features 12642 that are adapted to lockingly engagea plurality of proximally-facing, radial grooves or recesses 12634 thatare formed in the distal lock plate 12630. When the distal lock features12642 are in locking engagement with the radial grooves 12634 in thedistal lock plate 12630, rotation of the rotary lock head 12640 willcause the distal lock plate 12630 to rotate within the distal framemember 12220. Also in at least one example, the rotary lock head 12640further comprises a second series of proximally-facing proximal lockfeatures 12644 that are adapted to lockingly engage a correspondingseries of lock grooves that are provided in the distal frame member12220. A locking spring 12646 serves to bias the rotary lock headdistally into locking engagement with the distal lock plate 12630. Invarious instances, the rotary lock head 12640 may be pulled proximallyby an unlocking cable or other member in the manner described herein. Inanother arrangement, the rotary drive shaft 12602 may be configured toalso move axially to move the rotary lock head 12640 axially within thedistal frame member 12220. When the proximal lock features 12644 in therotary lock head 12640 are in locking engagement with the series of lockgrooves in the distal frame member 12220, rotation of the rotary driveshaft 12602 will result in rotation of the surgical end effector 12200about the shaft axis SA.

In certain instances, the first and second jaws 12250, 12270 are openedand closed as follows. To open and close the jaws, as was discussed indetail above, the rotary lock head 12640 is in locking engagement withthe distal lock plate 12630. Thereafter, rotation of the rotary driveshaft 12602 in a first direction will rotate the distal lock plate 12630which will axially drive the actuator yoke assembly 12610 in the distaldirection DD and move the first jaw 12250 and the second jaw 12270toward an open position. Rotation of the rotary drive shaft 12602 in anopposite second direction will axially drive the actuator yoke assembly12610 proximally and pull the jaws 12250, 12270 toward a closedposition. To rotate the surgical end effector 12200 about the shaft axisSA, the locking cable or member is pulled proximally to cause the rotarylock head 12640 to disengage from the distal lock plate 12630 and engagethe distal frame member 12220. Thereafter, when the rotary drive shaft12602 is rotated in a desired direction, the distal frame member 12220(and the surgical end effector 12200) will rotate about the shaft axisSA.

FIG. 27 further illustrates an electrical connection assembly 5000 forelectrically coupling the jaws 12250, 12270 to one or more power sourcessuch as, for example, generators 3106, 3107 (FIG. 36). The electricalconnection assembly 5000 defines two separate electrical pathways 5001,5002 extending through the electrosurgical instrument 12000, asillustrated in FIG. 27. In a first configuration, the electricalpathways 5001, 5002 cooperate to deliver bipolar energy to the endeffector 12200 where one of the electrical pathways 5001, 5002 acts as areturn pathway. In addition, in a second configuration, the electricalpathways 5001, 5002 separately and/or simultaneously deliver monopolarenergy 12200. Accordingly, in the second configuration, both of theelectrical pathways 5001, 5002 can be used as supply pathways. Further,the electrical connection assembly 5000 can be utilized with othersurgical instruments described elsewhere herein (e.g. the surgicalinstrument 1500) to electrically couple such surgical instruments withone or more power sources (e.g. generators 3106, 3107).

In the illustrated example, the electrical pathways 5001, 5002 areimplemented using a flex circuit 5004 extending, at least partially,through a coil tube 5005. As illustrated in FIG. 30, the flex circuit5004 includes two separate conductive trace elements 5006, 5007 embeddedin a PCB (printed circuit board) substrate 5009. In certain instances, aflex circuit 5004 could be attached to a core flat stamped metallicshaft member with a 3D printed or an over molded plastic casing toprovide full shaft fill/support.

In alternative examples, as illustrated in FIG. 32, a flex circuit 5004′extending through a coil tube 5005′ can include conductive traceelements 5006′, 5007′ twisted in a PCB substrate 5009′ in a helicalprofile resulting in a reduction of the overall size of the flex circuit5004′ and, in turn, a reduction in the inner/outer diameter of the coiltube 5005′. FIGS. 31 and 32 illustrate other examples of flex circuits5004″, 5004′″ extending through coil tubes 5005″, 5005′″ and includingconductive trace elements 5006″, 5007″ and 5006′″, 5007′″, respectively,which comprise alternative profiles for size reduction. For example, theflex circuit 5004′″ comprises a folded profile while the flex circuit5004″ comprises trace elements 5006″, 5007″ on opposite sides of the PCB5009″.

Further to the above, the pathways 5001, 5002 are defined by traceportions 5006 a-5006 g, 5007 a-5007 g, respectively. The trace portions5006 b, 5006 c and the trace portions 5007 b, 5007 c are in the form ofrings that define a ring assembly 5010 which maintains electricalconnections through the pathways 5001, 5002 while allowing rotation ofthe end effector 12200 relative to the shaft of the surgical instrument12000. Further, trace portions 5006 e, 5007 e are disposed on oppositesides of the actuator yoke assembly 12610. In the illustrated example,the portions 5006 e, 5007 e are disposed around holes configured toreceive the second jaw attachment pin 12273, as illustrated in FIG. 27.The trace portions 5006 e, 5007 e are configured to come into electricalcontact with corresponding portions 5006 f, 5007 f disposed on thesecond jaw 12270. In addition, the trace portions 5007 f, 5007 g becomeelectrically connected when the first jaw 12250 is assembled with thesecond jaw 12270.

Referring to FIG. 29, a flex circuit 5014 includes spring-biased traceelements 5016, 5017. The trace elements 5016, 5017 are configured toexert a biasing force against corresponding trace elements to ensuremaintaining an electrical connection therewith particularly whencorresponding trace portions are moving relative to one another. One ormore of the trace portions of the pathways 5001, 5002 can be modified toinclude spring-biased trace elements in accordance with the flex circuit5014.

Referring to FIG. 34, a graph 3000 illustrates a power scheme 3005′ of atissue treatment cycle 3001 applied by an end effector 1400, or anyother suitable end effector of the present disclosure, to a tissuegrasped by the end effector 1400. The tissue treatment cycle 3001includes a tissue coagulation stage 3006 including a feathering segment3008, a tissue-warming segment 3009, and a sealing segment 3010. Thetissue treatment cycle 3001 further includes a tissue transection orcutting stage 3007.

FIG. 36 illustrates an electrosurgical system 3100 including a controlcircuit 3101 configured to execute the power scheme 3005′. In theillustrated example, the control circuit 3101 includes a controller 3104with storage medium in the form of a memory 3103 and a processor 3102.The storage medium stores program instructions for executing the powerscheme 3005′. The electrosurgical system 3100 includes a generator 3106configured to supply monopolar energy to the end effector 1400, and agenerator 3107 configured to supply bipolar energy to the end effector1400, in accordance with the power scheme 3005′. In the illustratedexample, control circuit 3101 is depicted separately from the surgicalinstrument 1500 and the generators 3106, 3107. In other examples,however, the control circuit 3101 can be integrated with the surgicalinstrument 1500, the generator 3106, or the generator 3107. In variousaspects, the power scheme 3005′ can be stored in the memory 3103 in theform of an algorism, equation, and/or look-up table, or any suitableother suitable format. The control circuit 3101 may cause the generators3106, 3107 to supply monopolar and/or bipolar energies to the endeffector 1400 in accordance with the power scheme 3005′.

In the illustrated example, the electrosurgical system 3100 furtherincludes a feedback system 3109 in communication with the controlcircuit 3101. The feedback system 3109 can be a standalone system, orcan be integrated with the surgical instrument 1500, for example. Invarious aspects, the feedback system 3109 can be employed by the controlcircuit 3101 to perform a predetermined function such as, for example,issuing an alert when one or more predetermined conditions are met. Incertain instances, the feedback system 3109 may comprise one or morevisual feedback systems such as display screens, backlights, and/orLEDs, for example. In certain instances, the feedback system 3109 maycomprise one or more audio feedback systems such as speakers and/orbuzzers, for example. In certain instances, the feedback system 3109 maycomprise one or more haptic feedback systems, for example. In certaininstances, the feedback system 3109 may comprise combinations of visual,audio, and/or haptic feedback systems, for example. Additionally, theelectrosurgical system 3100 further includes a user interface 3110 incommunication with the control circuit 3101. The user interface 3110 canbe a standalone interface, or can be integrated with the surgicalinstrument 1500, for example.

The graph 3000 depicts power (W) on the y-axis and time on the x-axis. Abipolar energy curve 3020 spans the tissue coagulation stage 3005, and amonopolar energy curve 3030 starts in the tissue coagulation stage 3006and terminates at the end of the tissue transection stage 3007.Accordingly, tissue treatment cycle 3001 is configured to apply abipolar energy to the tissue throughout the tissue coagulation stage3006, but not the tissue transection stage 3007, and apply a monopolarenergy to the tissue in a portion of the coagulation stage 3006 and thetransection stage 3007, as illustrated in FIG. 34.

In various aspects, a user input can be received by the control circuit3101 from the user interface 3110. The user input causes the controlcircuit 3101 to initialize execution of the power scheme 3005′ at timet₁. Alternatively, the initialization of the execution of the powerscheme 3005′ can be triggered automatically by sensor signals from oneor more sensors 3111 in communication with the control circuit 3101. Forexample, the power scheme 3005′ can be triggered automatically by thecontrol circuit 3101 in response to a sensor signal indicative of apredetermined gap between the jaws 1450, 1470 of the end effector 1400.

During the feathering segment 3008, the control circuit 3101 causesgenerator 3107 to gradually increase the bipolar energy power suppliedto the end effector 1400 to a predetermined power value P1 (e.g. 100 W),and to maintain the bipolar energy power at, or substantially at, thepredetermined power value P1 throughout the remainder of the featheringsegment 3008 and the tissue-warming segment 3009. The predeterminedpower value P1 can be stored in the memory 3103 and/or can be providedby a user through the user interface 3110. During the sealing segment3010, the control circuit 3101 causes generator 3107 to graduallydecrease the bipolar energy power. Bipolar energy application isterminated at the end of the sealing segment 3010 of the tissuecoagulation stage 3006, and prior to the beginning of thecutting/transecting stage 3007.

Further to the above, at t₂, the control circuit 3101 causes generator3107 to begin supplying monopolar energy power to the electrode 1474 ofthe end effector 1400, for example. The monopolar energy application tothe tissue commences at the end of the feathering segment 3008 and thebeginning of the tissue-warming segment 3009. The control circuit 3101causes generator 3107 to gradually increase the monopolar energy powerto a predetermined power level P2 (e.g. 75 W), and to maintain, or atleast substantially maintain, the predetermined power level P2 for theremainder of the tissue-warming segment 3009 and a first portion of thesealing segment 3010. The predetermined power level P2 can also bestored in the memory 3103 and/or can be provided by a user through theuser interface 3110.

During the sealing segment 3010 of the tissue coagulation stage 3006,the control circuit 3101 causes generator 3107 to gradually increase themonopolar energy power supplied to the end effector 1400. The beginningof the tissue transection stage 3007 is ushered by an inflection pointin the monopolar energy curve 3030 where the previous gradual increasein monopolar energy, experienced during the sealing segment 3010, isfollowed by a step up to a predetermined maximum threshold power levelP3 (e.g. 150 W) sufficient to transect the coagulated tissue.

At t₄, the control circuit 3101 causes generator 3107 to step up themonopolar energy power supplied to the end effector 1400 to thepredetermined maximum threshold power level P3, and to maintain, or atleast substantially maintain, predetermined maximum threshold powerlevel P3 for a predetermined time period (t₄-t₆), or to the end of thetissue transection stage 3007. In the illustrated example, the monopolarenergy power is terminated by the control circuit 3101 at t5. The tissuetransection continues mechanically, as the jaws 1450, 1470 continue toapply pressure on the grasped tissue until the end of the issuetransection stage 3007 at t₆. Alternatively, in other examples, thecontrol circuit 3101 may cause the generator 3107 to continue supplyingmonopolar energy power to the end effector 1400 to the end of the tissuetransection stage 3007.

Sensor readings of the sensors 3111 and/or a timer clock of theprocessor 3102 can be employed by the control circuit 3101 to determinewhen to cause the generator 3107 and/or the generator 3106 to begin,increase, decrease, and/or terminate energy supply to the end effector1400, in accordance with a power scheme such as, for example, the powerscheme 3005′. The control circuit 3101 may execute the power scheme3005′ by causing one or more timer clocks to count down from one or morepredetermined time periods (e.g. t₁-t₂, t₂-t₃, t₃-t₄, t₅-t₆) that can bestored in the memory 3103, for example. Although the power scheme 3005′is time based, the control circuit 3101 may adjust predetermined timeperiods for any of the individual segments 3008, 3009, 3010 and/or thestages 3006, 3007 based on sensor readings received from one or more ofthe sensors 3111 such as, for example, a tissue impedance sensor.

The end effector 1400 is configured to deliver three different energymodalities to the grasped tissue. The first energy modality, which isapplied to the tissue during the feathering segment 3008, includesbipolar energy but not monopolar energy. The second energy modality is ablended energy modality that includes a combination of monopolar energyand bipolar energy, and is applied to the tissue during the tissuewarming stage 3009 and the tissue sealing stage 3010. Lastly, the thirdenergy modality includes monopolar energy but not bipolar energy, and isapplied to the tissue during the cutting stage 3007. In various aspects,the second energy modality comprises a power level that is the sum 3040of the power levels of monopolar energy and bipolar energy. In at leastone example, the power level of the second energy modality includes amaximum threshold Ps (e.g. 120 W).

In various aspects, the control circuit 3101 causes the monopolar energyand the bipolar energy to be delivered to the end effector 1400 from twodifferent electrical generators 3106, 3107. In at least one example,energy from one of the generators 3106, 3107 can be detected using areturn path of the other generator, or utilizing attached electrodes ofthe other generator to short to an unintended tissue interaction.Accordingly, a parasitic loss of energy through a return path that isnot the intended can be detected by a generator connected to the returnpath. The inadvertent conductive path can be mitigated by effecting thevoltage, power, waveform, or timing between uses.

Integrated sensors within the flex circuits of the surgical instrument1500 can detect energizing/shorting of an electrode/conductive path whenno potential should be present and the ability to prevent thatconductive path once inadvertent use is sensed. Further, directionalelectronic gating elements that prevent cross talk from one generatordown the source of the other generator can also be utilized.

One or more of the electrodes described by the present disclosure (e.g.electrodes 1452, 1472, 1474 in connection with the jaws 1450, 1470) mayinclude a segmented pattern with segments that are linked together whenthe electrode is energized by a generator (e.g. generator 1100).However, when the electrode is not energized, the segments are separatedto prevent circuit shorting across the electrode to other areas of thejaw.

In various aspects, thermal resistive electrode material are utilizedwith the end effector 1400. The material can be configured to inhibitelectrical flow through electrodes that are at or above a predefinedtemperature level but continues to allow the energizing of otherportions of the electrodes that are below the temperature threshold.

FIG. 37 illustrates a table representing an alternative power scheme3005″ that can be stored in the memory 3103, and can be executed by theprocessor 3102 in a similar manner to the power scheme 3005′. Inexecuting the power scheme 3005″, the control circuit 3101 relies on jawaperture in addition to, or in lieu of, time in setting power values ofthe generators 3106, 3107. Accordingly, the power scheme 3005″ is ajaw-aperture based power scheme.

In the illustrated example, jaw apertures d₀, d₁, d₂, d₃, d₄ from thepower scheme 3005″ correspond to the time values t₁, t₂, t₃, t₄ from thepower scheme 3005′. Accordingly, the feathering segment corresponds to ajaw aperture from about d₁ to about d₂ (e.g. from about 0.700″ to about0.500″). In addition, the tissue-warming segment corresponds to a jawaperture from about d₂ to about d₃ (e.g. from about 0.500″ to about0.300″). Further, the sealing segment corresponds to a jaw aperture fromabout d₂ to about d₃ (e.g. from about 0.030″ to about 0.010″). Further,the tissue cutting stage corresponds to a jaw aperture from about d₃ toabout d₄ (e.g. from about 0.010″ to about 0.003″).

Accordingly, the control circuit 3101 is configured to cause thegenerator 3106 to begin supplying bipolar energy power to the endeffector 1400 when readings from one or more of the sensors 3111corresponds to the predetermined jaw aperture d1, for example, therebyinitializing the feathering segment. Likewise, the control circuit 3101is configured to cause the generator 3106 to stop supplying bipolarenergy power to the end effector 1400 when readings from one or more ofthe sensors 3111 corresponds to the predetermined jaw aperture d2, forexample, thereby terminating the feathering segment. Likewise, thecontrol circuit 3101 is configured to cause the generator 3107 to beginsupplying monopolar energy power to the end effector 1400 when readingsfrom one or more of the sensors 3111 corresponds to the predeterminedjaw aperture d2, for example, thereby initializing the warming segment.

In the illustrated example, the jaw aperture is defined by the distancebetween two corresponding datum points on the jaws 1450, 1470. Thecorresponding datum points are in contact with one another when the jaws1450, 1470 are in a closed configuration with no tissue therebetween.Alternatively, the jaw aperture can be defined by a distance between thejaws 1450, 1470 measured along a line intersecting the jaws 1450, 1470and perpendicularly intersecting a longitudinal axis extending centrallythrough the end effector 1500. Alternatively, the jaw aperture can bedefined by a distance between first and second parallel linesintersecting the jaws 1450, 1470, respectively. The distance is measuredalong a line extending perpendicularly to the first and second parallellines, and extending through the intersection point between the firstparallel line and the first jaw 1450, and through the intersection pointbetween the second parallel line and the second jaw 1470.

Referring to FIG. 35, in various examples, an electrosurgical system3100 (FIG. 36) is configured to perform a tissue treatment cycle 4003using a power scheme 3005. The tissue treatment cycle 4003 includes aninitial tissue contacting stage 4013, a tissue coagulation stage 4006,and a tissue transection stage 4007. The tissue contacting stage 4013include an open configuration segment 4011 where tissue is not betweenthe jaws 1450 and 1470, and a proper orientation segment 4012 where thejaws 1450 and 1470 are properly positioned with respect to a desiredtissue treatment region. The tissue coagulation stage 4006 includes afeathering segment 4008, a tissue-warming segment 4009, and the sealingsegment 3010. The tissue transection stage 4007 includes atissue-cutting segment. The tissue treatment cycle 4003 involvesapplication of a bipolar energy and a monopolar energy separately andsimultaneously to the tissue treatment region in accordance with a powerscheme 3005. The tissue treatment cycle 4003 is similar in many respectsto the tissue treatment cycle 3001, which are not repeated herein in thesame level of detail for brevity.

FIG. 35 illustrates a graph 4000 that represents a power scheme 3005similar in many respects to the power scheme 3005′. For example, thecontrol circuit 3101 can execute the power scheme 3005, in a similarmanner to the power scheme 3005′, to deliver three different energymodalities to the tissue treatment region at three consecutive timeperiods of a tissue treatment cycle 4001. The first energy modality,which includes bipolar energy but not monopolar energy, is applied tothe tissue treatment region from t₁ to t₂, in the feathering segment4008. The second energy modality, which is a blended energy modalitythat includes a combination of monopolar energy and bipolar energy, isapplied to the tissue treatment region from t₂ to t₄, in thetissue-warming segment 4009 and tissue-sealing segment. Lastly, thethird energy modality, which includes monopolar energy but not bipolarenergy 4010, is applied to the tissue from t₄ to t₅, in tissuetransection stage 4007. Furthermore, the second energy modalitycomprises a power level that is the sum of the power levels of monopolarenergy and bipolar energy. In at least one example, the power level ofthe second energy modality includes a maximum threshold (e.g. 120 W). Invarious aspects, the power scheme 3005 can be delivered to the endeffector 1400 from two different electrical generators 3106, 3107.Additional aspects of the power scheme 3005 that are similar to aspectsof the power scheme 3005′ are not repeated herein in the same level ofdetail for brevity.

In various aspects, the control circuit 3101 causes the generators 3106,3107 to adjust the bipolar and/or monopolar power levels of the powerscheme 3005 applied to the tissue treatment region by the end effector1400 based on one or more measured parameters including tissue impedance4002, jaw motor velocity 27920 d, jaw motor force 27920 c, jaws aperture27920 b of the end effector 1400, and/or current draw of the motoreffecting the end effector closure. FIG. 35 is a graph 4000 illustratingcorrelations between such measured parameters and the power scheme 3005over time.

In various examples, the control circuit 3101 causes the generators3106, 3107 to adjust the power levels of a power scheme (e.g. powerschemes 3005, 3005′) applied by the end effector 1400 to the tissuetreatment region based on one or more parameters (e.g. tissue impedance4002, jaw/closure motor velocity 27920 d, jaw/closure motor force 27920c, jaws gap/aperture 27920 b of the end effector 1400, and/or currentdraw of the motor) determined by one or more sensors 3111. For example,the control circuit 3101 may cause the generators 3106, 3107 to adjustthe power levels based on the pressure within the jaws 1450, 1470.

In at least one example, the power levels are inversely proportional tothe pressure within the jaws 1450, 1470. The control circuit 3101 mayutilize such an inverse correlation to select the power levels based onthe pressure values. In at least one example, current draw of the motoreffecting the end effector closure is employed to determine the pressurevalues. Alternatively, the inverse correlation utilized by the controlcircuit 3101 can be directly based on the current draw as a proxy forthe pressure. In various examples, the greater the compression appliedby the jaws 1450, 1470 onto the tissue treatment region, the lower thepower levels set by the control circuit 3101, which aids in minimizingsticking and inadvertent cutting of the tissue.

Graph 4000 provides several cues in the measured parameters of tissueimpedance 4002, jaw/closure motor velocity 27920 d, jaw/closure motorforce 27920 c, jaws gap/aperture 27920 b of the end effector 1400,and/or current draw of the motor effecting the end effector closure,which can trigger an activation, an adjustment, and/or a termination ofthe bipolar energy and/or the monopolar energy application to tissueduring the tissue treatment cycle 4003.

The control circuit 3101 may rely on one or more of such cues inexecuting and/or adjusting the default power scheme 3005 in the tissuetreatment cycle 4003. In certain examples, the control circuit 3101 mayrely on sensor readings of the one or more sensors 3111 to detect whenone or more monitored parameters satisfy one or more predeterminedconditions that can be stored in the memory 3103, for example. The oneor more predetermined conditions can be reaching a predeterminedthreshold and/or detecting a meaningful increase and/or decrease in oneor more of the monitored parameters. Satisfaction of the predeterminedconditions, or the lack thereof, constitutes trigger/confirmation pointsfor executing and/or adjusting portions of the default power scheme 3005in the tissue treatment cycle 4003. The control circuit 3101 may relyexclusively on the cues in executing and/or adjusting a power scheme or,alternatively, use the cues to guide, or adjust, a timer clock of atime-based power scheme such as, for example, the power scheme 3005′.

For example, a sudden decrease (A₁) in tissue impedance to apredetermined threshold value (Z₁), occurring alone or coinciding withan increase (A₂) in jaw motor force to a predetermined threshold value(F₁) and/or a decrease (A₃) in jaw aperture to a predetermined thresholdvalue (d1) (e.g. 0.5″) may trigger the control circuit 3101 to begin thefeathering segment 4008 of the tissue coagulation stage 4006 byactivating the application of bipolar energy to the tissue treatmentregion. The control circuit 3101 may signal the generator 3106 to beginsupplying bipolar power to the end effector 1400.

Furthermore, a decrease (B₁) in jaw motor velocity to a predeterminedvalue (v1) following the activation of the bipolar energy triggers thecontrol circuit 3101 to signal the generator 3106 to stabilize (B₂) thepower level for bipolar energy at a constant, or at least substantiallyconstant, value (e.g. 100 W).

In yet another example, the shifting from the feathering segment 4008 tothe warming segment 4009 at t₂, which triggers an activation (D1) of themonopolar energy application to the tissue treatment region, coincideswith an increase (C₂) in the jaw motor force to a predeterminedthreshold (F₂), a decrease (C₃) in the jaw aperture to a predeterminedthreshold (e.g. 0.03″), and/or a decrease (C1) in tissue impedance to apredetermined value Z₂. Satisfaction of one, or in certain instancestwo, or in certain instances all, of the conditions C1, C2, C3 causesthe control circuit 3101 to cause the generator 3101 to beginapplication of monopolar energy to the tissue treatment region. Inanother example, satisfaction of one, or in certain instances two, or incertain instances all, of the conditions C1, C2, C3 at, or about, thetime t2, triggers the application of monopolar energy to the tissuetreatment region.

Activation of the monopolar energy by the generator 3107, in response toactivation signals by the control circuit 3101, causes a blend (D₁) ofthe monopolar energy and bipolar energy to be delivered to the tissuetreatment region, which causes a shift in the impedance curvecharacterized by a quicker decrease (E1) in impedance from Z₂ to Z₃ incomparison to a steady decrease (C1) prior to activation of themonopolar energy. In the illustrated example, the tissue impedance Z₃defines a minimum impedance for the tissue treatment cycle 4003.

In the illustrated example, the control circuit 3101 determines that anacceptable seal is being achieved if (E₁) the minimum impedance value Z₃coincides, or at least substantially coincides, with (E₃) apredetermined maximum jaw motor force threshold (F₃) and/or (E₂) apredetermined jaw aperture threshold range (e.g. 0.01″-0.003″).Satisfaction of one, or in certain instances two, or in certaininstances all, of the conditions E1, E2, E3 signals the control circuit3101 to shift from the warming segment 4009 to the sealing segment 4010.

Further to the above, beyond the minimum impedance value Z₃, theimpedance level gradually increases to a threshold value Z4corresponding to the end of the sealing segment 4010, at t₄.Satisfaction of the threshold value Z4 causes the control circuit 3101to signal the generator 3107 to step up the monopolar power level tocommence the tissue transection stage 4007, and signal the generator3106 to terminate application of the bipolar energy application to thetissue treatment region.

In various examples, the control circuit 3101 can be configured to (G₂)verify that the jaw motor force is decreasing as (G₁) the impedancegradually increases from its minimum value Z₃, and/or (G₃) that the jawaperture has decreased to a predetermined threshold (e.g. 0.01″-0.003″),prior to stepping up the power level of the monopolar energy to cut thetissue.

If, however, the jaw motor force continues to increase, the controlcircuit 3101 may pause application of the monopolar energy to the tissuetreatment region for a predetermined time period to allow the jaw motorforce to begin decreasing. Alternatively, the control circuit may signalthe generator 3107 to deactivate the monopolar energy, and complete theseal using only the bipolar energy.

In certain instances, the control circuit 3101 may employ the feedbacksystem 3109 to alert a user and/or provide instructions orrecommendations to pause the application of the monopolar energy. Incertain instances, the control circuit 3101 may instruct the user toutilize on a mechanical knife to transect the tissue.

In the illustrated example, the control circuit 3101 maintains (H) thestepped up monopolar power until a spike (I) is detected in tissueimpedance. The control circuit 3101 may cause the generator 3107 toterminate (J) application of the monopolar energy to the tissue upondetection of the spike (I) in the impedance level to Z₅ following thegradual increase from Z₃ to Z₄. The spike indicates completion of thetissue treatment cycle 4003.

In various examples, the control circuit 3101 prevents the electrodes ofthe jaws 1450, 1470 from being energized before a suitable closurethreshold is reached. The closure threshold can be based on apredetermined jaw aperture threshold and/or a predetermined jaw motorforce threshold, for example, which can be stored in the memory 3103. Insuch examples, the control circuit 3101 may not act on user inputsthrough the user interface 3110 requesting of the treatment cycle 4003.In certain instances, the control circuit 3101 may respond by alertingthe user through the feedback system 3109 that the suitable closurethreshold has not been reached. The control circuit 3101 may also offerthe user an override option.

Ultimately between time t₄ and t₅, monopolar energy is the only energybeing delivered in order to cut the patient tissue. While the patienttissue is being cut, the force to clamp the jaws of the end effector mayvary. In instances where the force to clamp the jaws decreases 27952from its steady-state level maintained between time t₃ and t₄, anefficient and/or effective tissue cut is recognized by the surgicalinstrument and/or the surgical hub. In instances where the force toclamp the jaws increases 27954 from its steady-state level maintainedbetween time t₃ and t₄, an inefficient and/or ineffective tissue cut isrecognized by the surgical instrument and/or the surgical hub. In suchinstances, an error can be communicated to the user.

Referring to FIGS. 38-42, a surgical instrument 1601 includes an endeffector 1600 similar in many respects to the end effectors 1400, 1500,which are not repeated herein in the same level of detail for brevity.The end effector 1600 includes a first jaw 1650 and a second jaw 1670.At least one of the first jaw 1650 and the second jaw 1670 is movable totransition the end effector 1600 from an open configuration to a closedconfiguration to grasp tissue (T) between the first jaw 1650 and thesecond jaw 1670. Electrodes 1652, 1672 are configured to cooperate todeliver a bipolar energy to the tissue from a bipolar energy source1610, as illustrated in FIG. 39. An electrode 1674 is configured todeliver a monopolar energy to the tissue from a monopolar energy source1620. A return pad 1621 defines a return pathway for the monopolarenergy. In at least one example, the monopolar energy and the bipolarenergy are delivered to the tissue either simultaneously (FIG. 36), orin an alternating fashion, as illustrated in FIG. 36, to seal and/or cutthe tissue, for example.

FIG. 42 illustrates a simplified schematic diagram of an electrosurgicalsystem 1607 includes a monopolar power source 1620 and bipolar powersource 1610 connectable to an electrosurgical instrument 1601 thatincludes the end effector 1600. The electrosurgical system 1607 furtherincludes a conductive circuit 1602 selectively transitionable between aconnected configuration with the electrode 1672 and a disconnectedconfiguration with the electrode 1672. The switching mechanism can becomprised of any suitable switch that can open and close the conductivecircuit 1602, for example. In the connected configuration, the electrode1672 is configured to cooperate with the electrode 1652 to deliverbipolar energy to the tissue, wherein the conductive circuit 1602defines a return path for the bipolar energy after passing through thetissue. However, in the disconnected configuration, the electrode 1672is isolated and therefore becomes an inert internally conductive andexternally insulated structure on the jaw 1670. Accordingly, in thedisconnected configuration the electrode 1652 is configured to deliver amonopolar energy to the tissue in addition to, or separate from, themonopolar energy delivered through the electrode 1674. In alternativeexamples, the electrode 1652, instead of the electrode 1672, can betransitionable between a connected configuration and a disconnectedconfiguration with the conductive circuit 1602, allowing the electrode1672 deliver monopolar energy to the tissue in addition to, or separatefrom, the monopolar energy delivered through the electrode 1674.

In various aspects, the electrosurgical instrument 1601 further includesa control circuit 1604 configured to adjust levels of the monopolarenergy and the bipolar energy delivered to the tissue to minimizeunintended thermal damage to surrounding tissue. The adjustments can bebased on readings of at least one sensor such as, for example, atemperature sensor, an impedance sensor, and/or a current sensor. In theexample illustrated in FIGS. 41 and 42, the control circuit 1604 iscoupled to temperature sensors 1651, 1671 on the jaws 1650, 1670,respectively. The levels of the monopolar energy and the bipolar energydelivered to the tissue are adjusted by the control circuit 1604 basedon temperature readings of the sensors 1651, 1671.

In the illustrated example, the control circuit 1604 includes acontroller 3104 with a storage medium in the form of a memory 3103 and aprocessor 3102. The memory 3103 stores program instructions that, whenexecuted by the processor 3102, cause the processor 3102 to adjustlevels of the monopolar energy and the bipolar energy delivered to thetissue based on sensor readings received from one or more sensors suchas, for example, the temperature sensors 1651, 1671. In variousexamples, as described in greater detail below, the control circuit 1604may adjust a default power scheme 1701 based on readings from one ormore sensors such as, for example, the temperature sensors 1651, 1671.The power scheme 1701 is similar in many respects to the power scheme3005′, which are not repeated herein in the same level of detail forbrevity.

FIG. 43 illustrates a temperature-based adjustment of the power scheme1701 for energy delivery to a tissue grasped by an end effector 1600. Agraph 1700 depicts time on the x-axis, and power and temperature on they-axis. In a tissue feathering segment (t₁-t₂), the control circuit 1604causes the power level of the bipolar energy to gradually increase up toa predetermined threshold (e.g. 120 W), which causes the temperature ofthe tissue grasped by the end effector 1600 to gradually increase to atemperature within a predetermined range (e.g. 100° C.-120° C.). Thepower level of the bipolar energy is then maintained at thepredetermined threshold as long as the tissue temperature remains withinthe predetermined range. In a tissue-warming segment (t₂-t₃), thecontrol circuit 1604 activates the monopolar energy, and graduallydecreases the power level of the bipolar energy, while graduallyincreasing the power level of the monopolar energy to maintain thetissue temperature within the predetermined range.

In the illustrated example, during a tissue-sealing segment (t₃-t₄), thecontrol circuit 1604 detects that the tissue temperature has reached theupper limit of the predetermined range based on readings the temperaturesensors 1651, 1671. The control circuit 1604 responds by stepping downthe power level of the monopolar energy. In other examples, thereduction can be performed gradually. In certain examples, the reductionvalue, or a manner for determining the reduction value such as, forexample, a table or an equation can be stored in the memory 3103. Incertain examples, the reduction value can be a percentage of the presentpower level of the monopolar energy. In other examples, the reductionvalue can be based on a previous power level of the monopolar energythat corresponded to a tissue temperature within the predeterminedrange. In certain examples, the reduction can be performed in multiplesteps that are temporally spaced apart. After each downward step, thecontrol circuit 1604 allows a predetermined time period to pass beforeevaluating the tissue temperature.

In the illustrated example, the control circuit 1604 maintains the powerlevel of the bipolar energy in accordance with the default power scheme1701, but reduces the power level of the monopolar energy to maintainthe temperature of the tissue within the predetermined range, whiletissue sealing is completed. In other examples, the reduction in thepower level of the monopolar energy is combined, or replaced, by areduction in the power level of the bipolar energy.

Further to the above, an alert can be issued, through the feedbacksystem 3109, to complete transection of the tissue using a mechanicalknife, for example, instead of the monopolar energy to avoid unintendedlateral thermal damage to surrounding tissue. In certain examples, thecontrol circuit 1604 may temporarily pause the monopolar energy and/orthe bipolar energy until the temperature of the tissue returns to alevel within the predetermined temperature range. Monopolar energy canthen be reactivated to perform a transection of the sealed tissue.

Referring to FIG. 44, an end effector 1600 is applying monopolar energyto a tissue treatment region 1683 at a blood vessel such as, forexample, an artery grasped by the end effector 1600. The monopolarenergy flows from the end effector 1600 to the treatment region 1683,and eventually to a return pad (e.g. return pad 1621). Temperature ofthe tissue at the treatment region 1683 rises as monopolar energy isapplied to the tissue. However, an actual thermal spread 1681 is greaterthan an expected thermal spread 1682, due to a constricted portion 1684of the artery that inadvertently draws the monopolar energy, forexample.

In various aspects, the control circuit 1604 monitors thermal effects atthe treatment region 1683 resulting from application of the monopolarenergy to the treatment region 1683. The control circuit 1604 canfurther detect a failure of the monitored thermal effects to comply witha predetermined correlation between the applied monopolar energy andthermal effects expected from application of the monopolar energy at thetreatment region. In the illustrated example, the inadvertent energydraw at the constricted portion of the artery reduces the thermaleffects at the treatment region, which is detected by the controlcircuit 1604.

In certain examples, the memory 3103 stores a predetermined correlationalgorithm between monopolar energy level, as applied to a tissuetreatment region grasped by the end effector 1600, and the thermaleffects expected to result from application of the monopolar energy tothe tissue treatment region. The correlation algorithm can be in theform of, for example, an array, lookup table, database, mathematicalequation, or formula, etc. In at least one example, the storedcorrelation algorithm defines a correlation between power levels of themonopolar energy and expected temperatures. The control circuit 1604 canmonitor the temperature of the tissue at the treatment region 1683 usingthe temperature sensors 1651, 1671, and can determine if a monitoredtemperature reading corresponds to an expected temperature reading at acertain power level.

The control circuit 1604 can be configured to take certain actions if afailure to comply with the stored correlation is detected. For example,the control circuit 1604 may alert a user of the failure. Additionally,or alternatively, the control circuit 1604 may reduce or pause deliveryof the monopolar energy to the treatment region. In at least oneexample, the control circuit 1604 may adjust, or shift, from themonopolar energy to a bipolar energy application to the tissue treatmentregion to confirm the presence of a parasitic power draw. The controlcircuit 1604 may continue using bipolar energy at the treatment regionif the parasitic power draw is confirmed. If, however, the controlcircuit 1604 refutes the presence of a parasitic power draw, the controlcircuit 1604 may reactivate, or re-increase, the monopolar power level.Changes to the monopolar and/or bipolar power levels can be achieved bythe control circuit 1604 by signaling the monopolar power source 1620and/or the bipolar power source 1610, for example.

In various aspects, one or more imaging devices such as, for example, amulti-spectral scope 1690 and/or an infrared imaging device can beutilized to monitor spectral tissue changes and/or the thermal effectsat a tissue treatment region 1691, as illustrated in FIG. 45. Imagingdata from the one or more imaging devices can be processed to estimatethe temperature at the tissue treatment region 1691. For example, a usermay direct the infrared imaging device at the treatment region 1691 asmonopolar energy is being applied to the treatment region 1691 by theend effector of 1600. As the treatment region 1691 heats up, itsinfrared heat signature changes. Accordingly, changes in the heatsignature correspond to changes in the temperature of the tissue at thetreatment region 1691. Accordingly, the temperature of the tissue at thetreatment region 1691 can be determined based on the heat signaturecaptured by the one or more imaging devices. If the temperatureestimated based on the heat signature at the treatment region 1691associated with a certain part level is less than or equal to anexpected temperature at the power level, the control circuit 1604detects a discrepancy in the thermal effects at the treatment region1691.

In other examples, the heat signature captured by the one or moreimaging devices is not converted into an estimated temperature. Instead,it is directly compared heat signatures stored into the memory 3103 toassess whether a power level adjustment is needed.

In certain examples, the memory 3103 stores a predetermined acorrelation algorithm between power levels of the monopolar energy, asapplied to a tissue treatment region 1691 by the end effector 1600, andthe heat signatures expected to result from application of the monopolarenergy to the tissue treatment region. The correlation algorithm can bein the form of, for example, an array, lookup table, database,mathematical equation, or formula, etc. In at least one example, thestored correlation algorithm defines a correlation between power levelsof the monopolar energy and expected heat signatures, or temperaturesassociated with the expected heat signatures.

Referring to FIGS. 46 and 47, an electrosurgical system includes anelectrosurgical instrument 1801 that has an end effector 1800 similar tothe end effectors 1400, 1500, 1600 in many respects, which are notrepeated herein in the same level of detail for brevity. The endeffector 1800 includes a first jaw 1850 and a second jaw 1870. At leastone of the first jaw 1850 and the second jaw 1870 is movable totransition the end effector 1800 from an open configuration to a closedconfiguration to grasp tissue (T) between the first jaw 1850 and thesecond jaw 1870. Electrodes 1852, 1872 are configured to cooperate todeliver a bipolar energy to the tissue. An electrode 1874 is configuredto deliver a monopolar energy to the tissue. In at least one example,the monopolar energy and the bipolar energy are delivered to the tissueeither simultaneously, or in an alternating fashion, as illustrated inFIG. 34, to seal and/or cut the tissue, for example.

In the illustrated example, the bipolar energy and monopolar energy aregenerated by separate generators 1880, 1881, and are provided to thetissue by separate electrical circuits 1882, 1883 that connect thegenerator 1880 to the electrodes 1852, 1872, and the generator 1881 tothe electrode 1874 and the return pad 1803, respectively. The powerlevels associated was the bipolar energy delivered to the tissue by theelectrodes 1852, 1872 is set by the generator 1880, and the power levelsassociated with the monopolar energy delivered to the tissue by theelectrode 1874 is set by the generator 1881, in accordance with thepower scheme 3005′, for example.

In use, as illustrated in FIG. 46, the end effector 1800 applies bipolarenergy and/or monopolar energy to a tissue treatment region 1804 to sealand, in certain instances, transect the tissue. However, in certaininstances, the energy is diverted from an intended target at the tissuetreatment region 1804 causing an off-site thermal damage to surroundingtissue. To avoid, or at least reduce, such occurrences, the surgicalinstrument 1801 includes impedance sensors 1810, 1811, 1812, 1813, whichare positioned between different electrodes and in different locations,as illustrated in FIG. 46, in order to detect off-site thermal damage.

In various aspects, the surgical system 1807 further includes a controlcircuit 1809 coupled to the impedance sensors 1810, 1811, 1812, 1813.The control circuit 1809 can detect an off-site, or an unintended,thermal damage based on one or more readings of the impedance sensors1810, 1811, 1812, 1813. In response, the control circuit 1809 may alerta user to the off-site thermal damage, and instruct the user to pauseenergy delivery to the tissue treatment region 1804, or automaticallypause the energy delivery, while maintaining the bipolar energy inaccordance with a predetermined power scheme (e.g. power scheme 3005′)to complete the tissue sealing. In certain instances, the controlcircuit 1809 may instruct the user to employ a mechanical knife totransect the tissue to avoid further off-site thermal damage.

Referring still to FIG. 46, the impedance sensor 1810 is configured tomeasure an impedance between the bipolar electrodes 1852, 1872. Further,the impedance sensor 1811 is configured to measure an impedance betweenthe electrode 1874 and the return pad 1803. In addition, the impedancesensor 1812 is configured to measure an impedance between the electrode1872 and the return pad 1803. In addition, the impedance sensor 1813 isconfigured to measure an impedance between the electrode 1852 and thereturn pad 1803. In other examples, additional impedance sensors areadded inline between the monopolar and bipolar circuits 1882, 1883,which can be utilized to measure impedances at various locations todetect off-site thermal abnormalities with greater specificity as to thelocation and impedance path.

In various aspects, the off-site thermal damage occurs in tissue on oneside (left/right) of the end effector 1800. The control circuit 1809 maydetect the side on which the off-site thermal damage has occurred bycomparing the readings of the impedance sensors 1810, 1811, 1812, 1813.In one example, a non-proportional change in the monopolar and bipolarimpedance readings is indicative of an off-site thermal damage. On thecontrary, if proportionality in the impedance readings is detected, thecontrol circuit 1809 maintains that no off-site thermal damage hasoccurred. In one example, as described in greater detail below, theoff-site thermal damage can be detected by the control circuit 1809 froma ratio of the bipolar to monopolar impedances.

FIG. 48 illustrates a graph 1900 depicting time on the x-axis and poweron the y-axis. The graph 1900 illustrates a power scheme 1901 similar inmany respects to the power scheme 3005′ illustrated in FIG. 34, whichare not repeated in the same level of detail herein for brevity. Acontrol circuit 3101 causes the power scheme 1901 to be applied by thegenerators 1880 (GEN. 2), 1881 (GEN. 1) to effect a tissue treatmentcycle by the end effector 1800. The power scheme 1901 includes atherapeutic power component 1902 and a nontherapeutic, or sensing, powercomponent 1903. The therapeutic power component 1902 defines monopolarand bipolar power levels similar to the monopolar and bipolar powerlevels described in connection with the power scheme 3005′. The sensingpower component 1903 includes monopolar 1905 and bipolar 1904 sensingpings delivered at various points throughout the tissue treatment cycleperformed by the end effector 1800. In at least one example, the sensingpings 1903, 1904 of the sensing power component are delivered at apredetermined current value (e.g. 10 mA) or a predetermined range. In atleast one example, three different sensing pings are utilized todetermine location/orientation of a potential off-site thermal damage.

The control circuit 3101 may determine whether energy is being divertedto a non-tissue therapy directed site during a tissue treatment cycle bycausing the sensing pings 1903, 1904 to be delivered at predeterminedtime intervals. The control circuit 3101 may then assess return-pathconductivity based on the delivered sensing pings. If it is determinedthat energy is being diverted from a target site, the control circuit3101 can take one or more reactive measures. For example, the controlcircuit 3101 can adjust the power scheme 1901 to be applied by thegenerators 1880 (GEN. 2), 1881 (GEN. 1). The control circuit 3101 maypause bipolar and/or monopolar energy application to the target site.Further, the control circuit 3101 may issue an alert to a user throughfeedback system 3109, for example. If, however, determines that noenergy diversion is detected, the control circuit 3101 continuesexecution of the power scheme 1901.

In various aspects, the control circuit 3101 assesses return-pathconductivity by comparing a measured return-conductivity to apredetermined return-path conductivity stored in the memory 3103, forexample. If the comparison indicates that the measured and predeterminedreturn-path conductivities are different beyond a predeterminedthreshold, the control circuit 3101 concludes that energy is beingdiverted to a non-tissue therapy directed site, and performs one or moreof the previously described reactive measures.

FIG. 49 is a graph 2000 illustrating a power scheme 2001 interrupted, att3′, due to a detected off-site thermal damage. The power scheme 2001 issimilar in many respects to the power schemes illustrated in FIGS. 34,48, which are not repeated herein in the same level of detail forbrevity. The control circuit 1809 causes the generators 1880 (curve line2010), 1881 (curve line 2020) to apply the power scheme 2001 to effect atissue treatment cycle by the end effector 1800, for example. Inaddition to the power scheme 2001, the graph 2000 further depictsbipolar impedance 2011 (Z_(bipolar)), monopolar impedance 2021(Z_(monopolar)), and a ratio 2030 (Z_(monopolar)/Z_(bipolar)) of themonopolar impedance to the bipolar impedance on the y-axis. Duringnormal operation, while the monopolar energy and the bipolar energy arebeing applied to the tissue simultaneously, values of the bipolarimpedance 2011 (Z_(bipolar)) and monopolar impedance 2021(Z_(monopolar)) remain proportional, or at least substantiallyproportional. It follows that a constant, or at least substantiallyconstant, impedance ratio 2030 (Z_(monopolar)/Z_(bipolar)) of themonopolar impedance 2021 to the bipolar impedance 2011 is maintainedwithin a predetermined range 2031 during normal operation.

In various aspects, the control circuit 1809 monitors the impedanceratio 2030 to assess whether the monopolar energy is diverting tonon-tissue therapy directed site. The diversion changes theproportionality of the detected values of the bipolar impedance 2011(Z_(bipolar)) and monopolar impedance 2021 (Z_(monopolar)), whichchanges the impedance ratio 2030. A change in the impedance ratio 2030within the predetermined range 2031 may cause the control circuit 1908to issue a warning. If, however, the change extends to, or below, alower threshold of the predetermined range 2031 the control circuit 1908may take additional reactive measures.

In the illustrated example, the impedance ratio 2030(Z_(monopolar)/Z_(bipolar)) remains constant, or at least substantiallyconstant, for an initial part of treatment cycle that involves a blendedmonopolar and bipolar energy application to the tissue. At B1, however,a discrepancy occurs where the monopolar impedance (Z_(monopolar)) dropsunexpectedly, or un-proportionally with, the bipolar impedance(Z_(bipolar)) indicating a potential off-site thermal damage. In atleast one example, the control circuit 1809 monitors changes in theratio of ratio (Z_(monopolar)/Z_(bipolar)) of the monopolar impedance tothe bipolar impedance, and detects an off-site thermal damage if thechanges persist for a predetermined amount of time, and/or change invalue to, or below, a lower threshold of the predetermined range 2031.At B1, since the detected the impedance ratio 2030 is still within thepredetermined range 2031, the control circuit 3101 only issues a warningthrough the feedback system 3109 that an off-site thermal damage hasbeen detected, and continues to monitor the impedance ratio 2030.

At t3′, the control circuit 3101 further detects that the impedanceratio 2030 has changed to a value at, or below, a lower threshold of thepredetermined range 2031. In response, the control circuit 3101 mayissue another warning and, optionally, may instruct the user to pauseenergy delivery to the tissue, or automatically pause the energydelivery, at B2, while maintaining or adjusting the power level of thebipolar energy to complete the tissue sealing without monopolar energy.In certain examples, the control circuit 1809 further instructs the userto employ a mechanical knife (t4′) to transect the tissue to avoidfurther off-site thermal damage. In the illustrated example, the controlcircuit 1809 further causes the generator 1880 to adjust its power levelto complete the tissue sealing without monopolar energy, and increasesthe time period allotted for the tissue sealing segment from time t4 totime t4′. In other words, the control circuit 1809 increases the bipolarenergy delivery to the tissue to compensate for the loss of monopolarenergy by increasing the bipolar power level and its delivery time.

Various aspects of the subject matter described herein are set out inthe following examples.

Various aspects of the subject matter described herein are set out inthe following examples.

Example Set 1

Example 1—An electrosurgical instrument comprising an end effector. Theend effector comprises a first jaw and a second jaw. At least one of thefirst jaw and the second jaw is movable to transition the end effectorfrom an open configuration to a closed configuration to grasp tissuetherebetween. The second jaw comprises a gradually narrowing bodyextending from a proximal end to a distal end. The gradually narrowingbody comprises a conductive material. The gradually narrowing bodycomprises a first conductive portion extending from the proximal end tothe distal end and a second conductive portion defining a taperedelectrode protruding from the first conductive portion and extendingdistally along at least a portion of the gradually narrowing body. Thesecond conductive portion is integral with the first conductive portion.The first conductive portion is thicker than the second conductiveportion in a transverse cross-section of the gradually narrowing body.The second jaw further comprises an electrically insulative layerconfigured to electrically insulate the first conductive portion fromthe tissue but not the second conductive portion. The first conductiveportion is configured to transmit an electrical energy to the tissueonly through the second conductive portion.

Example 2—The electrosurgical instrument of Example 1, wherein thetapered electrode comprises an outer surface flush with an outer surfaceof the electrically insulative layer.

Example 3—The electrosurgical instrument of Examples 1 or 2, wherein thetapered electrode comprises a width that gradually narrows as thetapered electrode extends from the proximal end toward the distal end.

Example 4—The electrosurgical instrument of Examples 1, 2, or 3, whereinthe electrical energy is delivered to the tissue through an outersurface of the tapered electrode.

Example 5—The electrosurgical instrument of Examples 1, 2, 3, or 4,wherein the first jaw comprises a first electrode extending distallyalong at least a portion of the first jaw, wherein the tapered electrodeis a second electrode, and wherein the first electrode is laterallyoffset from the second electrode in the closed configuration.

Example 6—The electrosurgical instrument of Example 5, wherein thesecond jaw further comprises a third electrode spaced apart from thenarrowing gradually body.

Example 7—The electrosurgical instrument of Example 6, wherein the thirdelectrode extends distally along an angular profile defined by thesecond jaw from an electrode proximal end to an electrode distal end.

Example 8—The electrosurgical instrument of Example 7, wherein the thirdelectrode comprises a base positioned in a cradle extending distallyalong the angular profile of the second jaw from a cradle proximal andto a cradle distal end.

Example 9—The electrosurgical instrument of Example 8, wherein thecradle is centrally situated with respect to lateral edges the secondjaw.

Example 10—The electrosurgical instrument of Examples 8 or 9, whereinthe third electrode further comprises a tapered edge extending from thebase beyond sidewalls of the cradle.

Example 11—The electrosurgical instrument of Examples 8, 9, or 10,wherein the cradle is comprised of a compliant substrate.

Example 12—The electrosurgical instrument of Examples 8, 9, 10, or 11,wherein the cradle is partially embedded in a valley defined in thegradually narrowing body.

Example 13—The electrosurgical instrument of Examples 8, 9, 10, 11, or12, wherein the cradle is spaced apart from the gradually narrowing bodyby an electrically insulative coating.

Example 14—The electrosurgical instrument of Examples 8, 9, 10, 11, 12,or 13, wherein the base comprises a base proximal end, a base distalend, and a width that gradually narrows as the base extends along theangular profile from the base proximal end to the base distal end.

Example 15—An electrosurgical instrument comprising an end effector. Theend effector comprises a first jaw and a second jaw. At least one of thefirst jaw and the second jaw is movable to transition the end effectorfrom an open configuration to a closed configuration to grasp tissuetherebetween. The second jaw comprises a conductive body comprising atapered angular profile extending from a proximal end to a distal end.The conductive body comprises a first conductive portion extending fromthe proximal end to the distal end and a second conductive portiondefining a tapered electrode protruding from the first conductiveportion and extending distally along at least a portion of theconductive body. The second conductive portion is integral with thefirst conductive portion. The first conductive portion is thicker thanthe second conductive portion. The second jaw further comprises anelectrically insulative layer configured to electrically insulate thefirst conductive portion from the tissue but not the second conductiveportion. The first conductive portion is configured to transmit anelectrical energy to the tissue only through the second conductiveportion.

Example 16—The electrosurgical instrument of Example 15, wherein thetapered electrode comprises a width that gradually narrows as thetapered electrode extends from the proximal end toward the distal end.

Example 17—The electrosurgical instrument of Examples 15 or 16, whereinthe first jaw comprises a first electrode extending distally along atleast a portion of the first jaw, wherein the tapered electrode is asecond electrode, and wherein the first electrode is laterally offsetfrom the second electrode in the closed configuration.

Example 18—The electrosurgical instrument of Examples 15, 16, or 17,wherein the second jaw further comprises a third electrode spaced apartfrom the conductive body.

Example 19—The electrosurgical instrument of Example 18, wherein thethird electrode extends distally along at least a portion of the taperedangular profile.

Example 20—The electrosurgical instrument of Example 19, wherein thethird electrode comprises a base positioned in a cradle extendingdistally along the at least a portion of the tapered angular profilefrom a cradle proximal and to a cradle distal end, and wherein thecradle is comprised of a compliant substrate.

Example Set 2

Example 1—An electrosurgical instrument comprising an end effector. Theend effector comprises a first jaw and a second jaw. At least one of thefirst jaw and the second jaw is movable to transition the end effectorfrom an open configuration to a closed configuration to grasp tissuetherebetween. The second jaw comprises linear portions cooperating toform an angular profile and a treatment surface comprising segmentsextending along the angular profile. The segments comprise differentgeometries and different conductivities. The segments are configured toproduce variable energy densities along the treatment surface.

Example 2—The electrosurgical instrument of Example 1, wherein thesegments comprise a proximal segment and a distal segment. The proximalsegment comprises a first surface area. The distal segment comprises asecond surface area. The second surface area is smaller than the firstsurface area.

Example 3—The electrosurgical instrument of Examples 1 or 2, wherein atleast one of the segments comprises conductive treatment regionslongitudinally interrupted by nonconductive treatment regions.

Example 4—The electrosurgical instrument of Examples 1, 2, or 3, whereinthe variable energy densities are predetermined based on a selection ofthe different geometries and different conductivities of the segments.

Example 5—The electrosurgical instrument of Examples 1, 2, 3, or 4,wherein at least one of the segments comprises a gradually narrowingwidth along its length.

Example 6—The electrosurgical instrument of Examples 1, 2, 3, 4, or 5,wherein the segments extend along a peripheral side of the second jaw.

Example 7—The electrosurgical instrument of Examples 1, 2, 3, 4, 5, or6, wherein the segments are defined in the second jaw but not the firstjaw.

Example 8—The electrosurgical instrument of Examples 1, 2, 3, 4, 5, 6,or 7, wherein the second jaw comprises an electrically conductiveskeleton partially coated with a first material and a second material,wherein the first material is thermally conductive but electricallyinsulative, and wherein the second material is thermally andelectrically insulative.

Example 9—The electrosurgical instrument of Example 8, wherein the firstmaterial comprises diamond-like carbon.

Example 10—The electrosurgical instrument of Examples 8 or 9, whereinthe second material comprises PolyTetraFluoroEthylene.

Example 11—An electrosurgical instrument comprising an end effector. Theend effector comprises a first jaw and a second jaw. At least one of thefirst jaw and the second jaw is movable to transition the end effectorfrom an open configuration to a closed configuration to grasp tissuetherebetween. The second jaw comprises a gradually narrowing bodyextending from a proximal end to a distal end. The gradually narrowingbody comprises a tissue contacting surface. The tissue contactingsurface comprises an insulative layer comprising a first material. Theinsulative layer extends on opposite sides of an intermediate areaextending along a length of the gradually narrowing body. The tissuecontacting surface further comprises segments configured to yieldvariable energy densities along the tissue contacting surface. Thesegments comprise conductive segments and insulative segmentsalternating with the conductive segments along the intermediate area.The insulative segments comprise a second material different from thefirst material.

Example 12—The electrosurgical instrument of Example 11, wherein theconductive segments comprise a proximal segment and a distal segment.The proximal segment comprises a first surface area. The distal segmentcomprises a second surface area. The second surface area is smaller thanthe first surface area.

Example 13—The electrosurgical instrument of Examples 11 or 12, whereinthe second jaw comprises an electrically conductive skeleton partiallycoated with the first material.

Example 14—The electrosurgical instrument of Example 13, wherein theelectrically conductive skeleton comprises an inner thermally-insulativecore and an outer thermally-conductive layer at least partiallysurrounding the inner thermally-insulative core.

Example 15—The electrosurgical instrument of Examples 11, 12, 13, or 14,wherein the variable energy densities are predetermined based on aselection of different geometries and different conductivities of theconductive segments.

Example 16—The electrosurgical instrument of Examples 11, 12, 13, 14, or15, wherein at least one of the segments comprises a gradually narrowingwidth along its length.

Example 17—The electrosurgical instrument of Examples 11, 12, 13, 14,15, or 16, wherein the segments extend along a peripheral side of thesecond jaw.

Example 18—The electrosurgical instrument of Examples 11, 12, 13, 14,15, 16, or 17, wherein the segments are defined in the second jaw butnot the first jaw.

Example 19—The electrosurgical instrument of Examples 11, 12, 13, 14,15, 16, 17, or 18, wherein the first material comprises diamond-likecarbon.

Example 20—The electrosurgical instrument of Examples 11, 12, 13, 14,15, 16, 17, 18, or 19, wherein the second material comprisesPolyTetraFluoroEthylene.

Example Set 3

Example 1—An electrosurgical instrument comprising an end effector. Theend effector comprises a first jaw, a second jaw, and an electricalcircuit. The first jaw comprises a first electrically conductiveskeleton, a first insulative coating selectively covering portions ofthe first electrically conductive skeleton, and first-jaw electrodescomprising exposed portions of the first electrically conductiveskeleton. At least one of the first jaw and the second jaw is movable totransition the end effector from an open configuration to a closedconfiguration to grasp tissue therebetween. The second jaw comprises asecond electrically conductive skeleton, a second insulative coatingselectively covering portions of the second electrically conductiveskeleton, and second-jaw electrodes comprising exposed portions of thesecond electrically conductive skeleton. The electrical circuit isconfigured to transmit a bipolar RF energy and a monopolar RF energy tothe tissue through the first-jaw electrodes and the second-jawelectrodes. The monopolar RF energy shares a first electrical pathwayand a second electrical pathway defined by the electrical circuit fortransmission of the bipolar RF energy.

Example 2—The electrosurgical instrument of Example 1, wherein theelectrical circuit defines a third electrical pathway separate from thefirst electrical pathway and the second electrical pathway.

Example 3—The electrosurgical instrument of Example 1 or 2, wherein theend effector comprises a cutting electrode electrically insulated fromthe first electrically conductive skeleton and the second electricallyconductive skeleton.

Example 4—The electrosurgical instrument of Example 3, wherein thecutting electrode is configured to receive a cutting monopolar RF energythrough the third electrical pathway.

Example 5—The electrosurgical instrument of Example 4, wherein thecutting electrode is configured to cut the tissue with the cuttingmonopolar RF energy after coagulation of the tissue has commenced withthe bipolar RF energy.

Example 6—The electrosurgical instrument of Examples 3, 4 or 5, whereinthe cutting electrode is centrally located in one of the first jaw andthe second jaw.

Example 7—The electrosurgical instrument of Examples 4 or 5, wherein theend effector is configured to simultaneously deliver the cuttingmonopolar RF energy and the bipolar RF energy to the tissue.

Example 8—The electrosurgical instrument of Examples 1, 2, 3, 4, 5, 6,or 7, wherein the first-jaw electrodes comprise a first distal-tipelectrode, and wherein the second-jaw electrodes comprise a seconddistal-tip electrode.

Example 9—The electrosurgical instrument of Example 8, wherein firstelectrically conductive skeleton and the second electrically conductiveskeleton are energized simultaneously to deliver the monopolar RF energyto a tissue surface through the first distal-tip electrode and thesecond distal-tip electrode.

Example 10—The electrosurgical instrument of Examples 1, 2, 3, 4, 5, 6,7, 8, or 9, wherein the second jaw comprises a dissection electrodeextending along a peripheral surface of the second jaw.

Example 11—An electrosurgical instrument comprising an end effector andan electrical circuit. The end effector comprises at least two electrodesets, a first jaw, and a second jaw. At least one of the first jaw andthe second jaw is movable to transition the end effector from an openconfiguration to a closed configuration to grasp tissue therebetween.The end effector is configured to deliver a combination of bipolar RFenergy and monopolar RF energy to the grasped tissue from the at leasttwo electrode sets. The electrical circuit is configured to transmit thebipolar RF energy and the monopolar RF energy. The monopolar RF energyshares an active pathway and a return pathway defined by the electricalcircuit for transmission of the bipolar RF energy.

Example 12—The electrosurgical instrument of Example 11, wherein the atleast two electrodes sets comprise three electrical interconnectionsthat are used together in the electrical circuit.

Example 13—The electrosurgical instrument of Examples 11 or 12, whereinthe at least two electrodes sets comprise three electricalinterconnections that define at least a portion of the electricalcircuit and another separate electrical circuit.

Example 14—The electrosurgical instrument of Example 13, wherein theseparate electrical circuit leads to a cutting electrode of the at leasttwo electrode sets that is isolated and centrally located in one of thefirst jaw and the second jaw.

Example 15—The electrosurgical instrument of Example 14, wherein thecutting electrode is configured to cut the tissue after coagulation ofthe tissue has commenced using second and third electrodes of the atleast two electrode sets.

Example 16—The electrosurgical instrument of Examples 14 or 15, whereinthe at least two electrode sets are configured to simultaneously deliverthe monopolar RF energy and the bipolar RF energy to the tissue.

Example 17—An electrosurgical instrument comprising an end effector. Theend effector comprises a first jaw and a second jaw. At least one of thefirst jaw and the second jaw is movable to transition the end effectorfrom an open configuration to a closed configuration to grasp tissuetherebetween. The second jaw comprises a composite skeleton of at leasttwo different materials that are configured to selectively yieldelectrically conductive portions and thermally insulted portions.

Example 18—The electrosurgical instrument of Example 17, wherein thecomposite skeleton comprises a titanium ceramic-composite.

Example 19—The electrosurgical instrument of Examples 17 or 18, whereinthe composite skeleton comprises a ceramic base and a titanium crownattachable to the ceramic base.

Example 20—The electrosurgical instrument of Examples 17, 18, or 19,wherein the composite skeleton is partially coated with an electricallyinsulative material.

Example 21—A method for manufacturing a jaw of an end effector of anelectrosurgical instrument. The method comprises preparing a compositeskeleton of the jaw by fusing a titanium powder with a ceramic powder ina metal injection molding process and selectively coating the compositeskeleton with an electrically insulative material to yield a pluralityof electrodes.

Example Set 4

Example 1—An electrosurgical instrument comprising a first jaw and asecond jaw. The first jaw is configured to define a first electrode. Thefirst jaw comprises a first electrically conductive skeleton and a firstelectrically insulative layer. The first electrically conductiveskeleton comprises a first thermally insulative core and a firstthermally conductive outer layer integral with and extending at leastpartially around the first thermally insulative core. The firstelectrode is defined by selective application of the first electricallyinsulative layer to an outer surface of the first thermally conductiveouter layer. The second jaw is configured to define a second electrode.The second jaw comprises a second electrically conductive skeleton and asecond electrically insulative layer. The second electrically conductiveskeleton comprises a second thermally insulative core and a secondthermally conductive outer layer integral with and extending at leastpartially around the second thermally insulative core. The secondelectrode is defined by selective application of the second electricallyinsulative layer to an outer surface of the second thermally conductiveouter layer.

Example 2—The electrosurgical instrument of Example 1, wherein the firstelectrode is configured to transmit an RF energy to the second electrodethrough tissue positioned therebetween in a bipolar energy mode ofoperation.

Example 3—The electrosurgical instrument of Examples 1 or 2, wherein thefirst thermally insulative core comprises air pockets.

Example 4—The electrosurgical instrument of Examples 1, 2, or 3, whereinthe first thermally insulative core comprises a lattice structure.

Example 5—The electrosurgical instrument of Examples 1, 2, 3, or 4,wherein the second jaw comprises a third electrode, and wherein thethird electrode is defined by selective application of the secondelectrically insulative layer to the outer surface of the secondthermally conductive outer layer.

Example 6—The electrosurgical instrument of Example 5, wherein the thirdelectrode is configured to deliver an RF energy to tissue in contactwith the third electrode in a monopolar energy mode of operation.

Example 7—The electrosurgical instrument of Examples 1, 2, 3, 4, 5, or6, wherein at least one of the first electrically insulative layer andthe second electrically insulative layer comprises a diamond-likematerial.

Example 8—The electrosurgical instrument of Examples 1, 2, 3, 4, 5, 6,or 7, wherein the first jaw comprises a tissue-contacting surface, andwherein the first thermally insulative core comprises a latticestructure including walls erected in a direction that transects thetissue-contacting surface.

Example 9—The electrosurgical instrument of Example 8, wherein thedirection is perpendicular to the tissue-contacting surface.

Example 10—An electrosurgical instrument comprising a jaw configured todefine an electrode. The jaw comprises a first electrically conductiveportion, a second electrically conductive portion, and an electricallyinsulative layer. The first electrically conductive portion isconfigured to resist heat transfer therethrough. The second electricallyconductive portion is integral with and extending at least partiallyaround the first electrically conductive portion. The secondelectrically conductive portion is configured to define a heat sink. Theelectrode is defined by selective application of the electricallyinsulative layer to an outer surface of the second electricallyconductive portion.

Example 11—The electrosurgical instrument of Example 10, wherein theelectrode is configured to transmit an RF energy to tissue positionedagainst the electrode.

Example 12—The electrosurgical instrument of Examples 10 or 11, whereinthe first electrically conductive portion comprises air pockets.

Example 13—The electrosurgical instrument of Examples 10, 11, or 12,wherein the first electrically conductive portion comprises a latticestructure.

Example 14—The electrosurgical instrument of Examples 10, 11, 12, or 13,wherein the electrically insulative layer comprises a diamond-likematerial.

Example 15—The electrosurgical instrument of Examples 10, 11, 12, 13, or14, wherein the jaw comprises a tissue-contacting surface, and whereinthe first electrically conductive portion comprises a lattice structureincluding walls erected in a direction that transects thetissue-contacting surface.

Example 16—The electrosurgical instrument of Example 15, wherein thedirection is perpendicular to the tissue-contacting surface.

Example 17—An electrosurgical instrument comprising a jaw configured todefine an electrode. The jaw comprises an electrically conductiveskeleton and an electrically insulative layer. The electricallyconductive skeleton comprises a thermally insulative core and athermally conductive outer layer integral with and extending at leastpartially around the thermally insulative core. The electrode is definedby selective application of the electrically insulative layer to anouter surface of the thermally conductive outer layer.

Example 18—The electrosurgical instrument of Example 17, wherein thethermally insulative core comprises a lattice structure.

Example 19—The electrosurgical instrument of Example 18, wherein the jawcomprises a tissue-contacting surface, and wherein the lattice structureincludes walls erected in a direction that transects thetissue-contacting surface.

Example 20—The electrosurgical instrument of Example 19, wherein thedirection is perpendicular to the tissue-contacting surface.

Example Set 5

Example 1—An electrosurgical instrument comprising an end effector. Theend effector comprises a first jaw and a second jaw. The first jawcomprises a first electrode. At least one of the first jaw and thesecond jaw is movable to transition the end effector from an openconfiguration to a closed configuration to grasp tissue therebetween.The second jaw comprises a second electrode configured to deliver afirst monopolar energy to the tissue, a third electrode, and aconductive circuit selectively transitionable between a connectedconfiguration with the third electrode and a disconnected configurationwith the third electrode. In the connected configuration, the thirdelectrode is configured to cooperate with the first electrode to deliverbipolar energy to the tissue. The conductive circuit defines a returnpath for the bipolar energy. In the disconnected configuration, thefirst electrode is configured to deliver a second monopolar energy tothe tissue.

Example 2—The electrosurgical instrument of Example 1, furthercomprising a switching mechanism for alternating between the connectedconfiguration and the disconnected configuration.

Example 3—The electrosurgical instrument of Examples 1 or 2, furthercomprising a switching mechanism for alternating between delivering thebipolar energy and the second monopolar energy to the tissue through thefirst electrode.

Example 4—The electrosurgical instrument of Examples 1, 2 or 3, whereinthe end effector is configured to deliver the bipolar energy and thefirst monopolar energy to the tissue simultaneously.

Example 5—The electrosurgical instrument of Examples 1, 2, 3, or 4,wherein the end effector is configured to deliver an energy blend of thebipolar energy and the first monopolar energy to the tissue.

Example 6—The electrosurgical instrument of Example 5, wherein levels ofthe bipolar energy and the first monopolar energy in the energy blendare determined based on at least one reading of a temperature sensorindicative of at least one temperature of the tissue.

Example 7—The electrosurgical instrument of Examples 5 or 6, whereinlevels of the bipolar energy and the first monopolar energy in theenergy blend are determined based on at least one reading of animpedance sensor indicative of at least one impedance of the tissue.

Example 8—The electrosurgical instrument of Examples 5, 6, or 7, whereinlevels of the bipolar energy and the first monopolar energy in theenergy blend are adjusted to reduce a detected lateral thermal damagebeyond a tissue treatment region between the first jaw and the secondjaw.

Example 9—An electrosurgical instrument comprising an end effector and acontrol circuit. The end effector comprises a first jaw, a second jaw,and at least one sensor. The first jaw comprises a first electrode. Atleast one of the first jaw and the second jaw is movable to transitionthe end effector from an open configuration to a closed configuration tograsp tissue therebetween. The second jaw comprises a second electrodeconfigured to deliver a monopolar energy to the tissue and thirdelectrode configured to cooperate with the first electrode to deliver abipolar energy. The control circuit is configured to execute apredetermined power scheme to seal and cut the tissue in a tissuetreatment cycle. The power scheme comprises predetermined power levelsof the monopolar energy and the bipolar energy. The control circuit isfurther configured to adjust at least one of the predetermined powerlevels of the monopolar energy and the bipolar energy based on readingsof at least one sensor during the tissue treatment cycle.

Example 10—The electrosurgical instrument of Example 9, wherein thepredetermined power scheme comprises a simultaneous application and aseparate application of the bipolar energy and the monopolar energy tothe tissue in the tissue treatment cycle.

Example 11—The electrosurgical instrument of Examples 9 or 10, whereinthe predetermined power scheme comprises an application of the bipolarenergy but not the monopolar energy to the tissue in a featheringsegment of the tissue treatment cycle and a simultaneous application ofthe bipolar energy and the monopolar energy to the tissue in a tissuewarming segment and a tissue sealing segment of the tissue treatmentcycle.

Example 12—The electrosurgical instrument of Example 11, wherein thepower scheme further comprises an application of the monopolar energybut not the bipolar energy to the tissue in a tissue transection segmentof the tissue treatment cycle.

Example 13—The electrosurgical instrument of Examples 9, 10, 11, or 12,wherein the at least one sensor comprises impedance sensors.

Example 14—The electrosurgical instrument of Example 13, wherein thecontrol circuit is configured to monitor an impedance ratio of amonopolar tissue-impedance to a bipolar tissue-impedance based onreadings from the impedance sensors.

Example 15—The electrosurgical instrument of Example 14, wherein achange in the impedance ratio within a predetermined range causes thecontrol circuit to issue a warning.

Example 16—The electrosurgical instrument of Example 15, wherein achange in the impedance ratio to, or below, a lower threshold of thepredetermined range causes the control circuit to adjust thepredetermined power scheme.

Example 17—The electrosurgical instrument of Examples 15 or 16, whereina change in the impedance ratio to, or below, a lower threshold of thepredetermined range causes the control circuit to pause an applicationof the monopolar energy to the tissue.

Example 18—The electrosurgical instrument of Example 17, wherein thechange in the impedance ratio to, or below, a lower threshold of thepredetermined range further causes the control circuit to adjust anapplication of the bipolar energy to the tissue to complete sealing thetissue.

Example 19—An electrosurgical instrument comprising an end effector anda control circuit. The end effector comprises a first jaw and a secondjaw. The first jaw comprising a first electrode. At least one of thefirst jaw and the second jaw is movable to transition the end effectorfrom an open configuration to a closed configuration to grasp tissuetherebetween. The tissue being at a target site. The second jawcomprises a second electrode configured to deliver a monopolar energy tothe tissue and a third electrode configured to cooperate with the firstelectrode to deliver a bipolar energy. The control circuit is configuredto execute a predetermined power scheme to seal and cut the tissue in atissue treatment cycle. The power scheme comprises predetermined powerlevels of the monopolar energy and the bipolar energy. The controlcircuit is further configured to detect an energy diversion off thetarget site and adjust at least one of the predetermined power levels ofthe monopolar energy and the bipolar energy to mitigate the energydiversion.

Example 20—The electrosurgical instrument of Example 19, wherein thepredetermined power scheme comprises a simultaneous application and aseparate application of the bipolar energy and the monopolar energy tothe tissue in the tissue treatment cycle.

Example 21—The electrosurgical instrument of Examples 19 or 20, whereinthe predetermined power scheme comprises an application of the bipolarenergy but not the monopolar energy to the tissue in a featheringsegment of the tissue treatment cycle and a simultaneous application ofthe bipolar energy and the monopolar energy to the tissue in a tissuewarming segment and a tissue sealing segment of the tissue treatmentcycle.

Example Set 6

Example 1—An electrosurgical system comprising an end effector and acontrol circuit. The end effector comprises a first jaw and a secondjaw. At least one of the first jaw and the second jaw is movable totransition the end effector from an open configuration to a closedconfiguration to grasp tissue therebetween. The control circuit isconfigured to cause an application of two different energy modalities tothe tissue simultaneously and separately during a tissue treatment cyclecomprising a tissue coagulation stage and a tissue transection stage.

Example 2—The electrosurgical system of Example 1, wherein the firstenergy modality is a monopolar energy modality.

Example 3—The electrosurgical system of Example 2, wherein the secondenergy modality is a bipolar energy modality.

Example 4—The electrosurgical system of Examples 2 or 3, wherein thecontrol circuit is configured to activate the application of themonopolar energy modality to the tissue prior to a completion of thetissue coagulation stage by the bipolar energy modality.

Example 5—The electrosurgical system of Examples 2 or 3, wherein thecontrol circuit is configured to activate the application of themonopolar energy modality to the tissue prior to deactivation of thebipolar energy modality application to the tissue.

Example 6—The electrosurgical system of Examples 3, 4, or 5, wherein thecontrol circuit is configured to cause a simultaneous application of themonopolar energy modality and the bipolar energy modality to the tissueduring the tissue coagulation stage.

Example 7—The electrosurgical system of Examples 1, 2, 3, 4, 5, or 6,wherein the control circuit comprises a processor and a storage medium,and wherein the application of the two different energy modalities tothe tissue is based on a default power scheme stored in the storagemedium.

Example 8—The electrosurgical system of Example 7, further comprising atleast one sensor, and wherein the control circuit is configured tomodify the default power scheme based on one more sensor readings of theat least one sensor.

Example 9—An electrosurgical instrument comprising an end effector. Theend effector comprises a first jaw and a second jaw. At least one of thefirst jaw and the second jaw is movable to transition the end effectorfrom an open configuration to a closed configuration to grasp tissuetherebetween. The end effector is configured to cause an application ofthree different energy modalities to the tissue during a tissuetreatment cycle comprising a tissue coagulation stage and a tissuetransection stage.

Example 10—The electrosurgical instrument of Example 9, wherein thefirst energy modality comprises a bipolar energy.

Example 11—The electrosurgical instrument of Example 10, wherein thesecond energy modality comprises an energy blend of a monopolar energyand the bipolar energy.

Example 12—The electrosurgical instrument of Example 11, wherein thethird energy modality comprises the monopolar energy but not the bipolarenergy.

Example 13—The electrosurgical instrument of Examples 11 or 12, whereinan activation of the monopolar energy application to the tissue isconfigured to begin prior to a completion of the tissue coagulationstage.

Example 14—The electrosurgical instrument of Examples 12 or 13, whereinan activation of the monopolar energy application to the tissue isconfigured to begin prior to a deactivation of the application of thebipolar energy modality to the tissue.

Example 15—The electrosurgical instrument of Examples 9, 10, 11, 12, 13,or 14, further comprising a control circuit, wherein the control circuitcomprises a processor and a storage medium, and wherein the applicationof the two different energy modalities to the tissue is based on adefault power scheme stored in the storage medium.

Example 16—The electrosurgical instrument of Example 15, furthercomprising at least one sensor, wherein the control circuit isconfigured to adjust the default power scheme during the tissuetreatment cycle based on one more sensor readings of the at least onesensor.

Example 17—An electrosurgical system comprising a first generatorconfigured output a bipolar energy, a second generator configured tooutput a monopolar energy, a surgical instrument electrically coupled tothe first generator and the second generator, and a control circuit. Thesurgical instrument comprises an end effector. The end effectorcomprises a first jaw and a second jaw. At least one of the first jawand the second jaw is movable to transition the end effector from anopen configuration to a closed configuration to grasp tissuetherebetween. The control circuit comprises a processor and a storagemedium comprising program instructions that, when executed by theprocessor, causes the processor to cause the first generator and thesecond generator to apply a predetermined power scheme to the endeffector. The power scheme comprises a simultaneous application and aseparate application of the bipolar energy and the monopolar energy tothe tissue in a tissue treatment cycle.

Example 18—The electrosurgical system of Example 17, further comprisingat least one sensor, wherein the control circuit is configured to adjustthe power scheme during the tissue treatment cycle based on one moresensor readings of the at least one sensor.

Example 19—The electrosurgical system of Examples 17 or 18, wherein thepower scheme comprises an application of the bipolar energy but not themonopolar energy to the tissue in a feathering segment of the tissuetreatment cycle, and a simultaneous application of the bipolar energyand the monopolar energy to the tissue in a tissue warming segment and atissue sealing segment of the tissue treatment cycle.

Example 20—The electrosurgical system of Examples 17, 18, or 19, whereinthe power scheme further comprises an application of the monopolarenergy but not the bipolar energy to the tissue in a tissue transectionsegment of the tissue treatment cycle.

While several forms have been illustrated and described, it is not theintention of Applicant to restrict or limit the scope of the appendedclaims to such detail. Numerous modifications, variations, changes,substitutions, combinations, and equivalents to those forms may beimplemented and will occur to those skilled in the art without departingfrom the scope of the present disclosure. Moreover, the structure ofeach element associated with the described forms can be alternativelydescribed as a means for providing the function performed by theelement. Also, where materials are disclosed for certain components,other materials may be used. It is therefore to be understood that theforegoing description and the appended claims are intended to cover allsuch modifications, combinations, and variations as falling within thescope of the disclosed forms. The appended claims are intended to coverall such modifications, variations, changes, substitutions,modifications, and equivalents.

The foregoing detailed description has set forth various forms of thedevices and/or processes via the use of block diagrams, flowcharts,and/or examples. Insofar as such block diagrams, flowcharts, and/orexamples contain one or more functions and/or operations, it will beunderstood by those within the art that each function and/or operationwithin such block diagrams, flowcharts, and/or examples can beimplemented, individually and/or collectively, by a wide range ofhardware, software, firmware, or virtually any combination thereof.Those skilled in the art will recognize that some aspects of the formsdisclosed herein, in whole or in part, can be equivalently implementedin integrated circuits, as one or more computer programs running on oneor more computers (e.g., as one or more programs running on one or morecomputer systems), as one or more programs running on one or moreprocessors (e.g., as one or more programs running on one or moremicroprocessors), as firmware, or as virtually any combination thereof,and that designing the circuitry and/or writing the code for thesoftware and or firmware would be well within the skill of one of skillin the art in light of this disclosure. In addition, those skilled inthe art will appreciate that the mechanisms of the subject matterdescribed herein are capable of being distributed as one or more programproducts in a variety of forms, and that an illustrative form of thesubject matter described herein applies regardless of the particulartype of signal bearing medium used to actually carry out thedistribution.

Instructions used to program logic to perform various disclosed aspectscan be stored within a memory in the system, such as dynamic randomaccess memory (DRAM), cache, flash memory, or other storage.Furthermore, the instructions can be distributed via a network or by wayof other computer readable media. Thus a machine-readable medium mayinclude any mechanism for storing or transmitting information in a formreadable by a machine (e.g., a computer), but is not limited to, floppydiskettes, optical disks, compact disc, read-only memory (CD-ROMs), andmagneto-optical disks, read-only memory (ROMs), random access memory(RAM), erasable programmable read-only memory (EPROM), electricallyerasable programmable read-only memory (EEPROM), magnetic or opticalcards, flash memory, or a tangible, machine-readable storage used in thetransmission of information over the Internet via electrical, optical,acoustical or other forms of propagated signals (e.g., carrier waves,infrared signals, digital signals, etc.). Accordingly, thenon-transitory computer-readable medium includes any type of tangiblemachine-readable medium suitable for storing or transmitting electronicinstructions or information in a form readable by a machine (e.g., acomputer).

As used in any aspect herein, the term “control circuit” may refer to,for example, hardwired circuitry, programmable circuitry (e.g., acomputer processor including one or more individual instructionprocessing cores, processing unit, processor, microcontroller,microcontroller unit, controller, digital signal processor (DSP),programmable logic device (PLD), programmable logic array (PLA), orfield programmable gate array (FPGA)), state machine circuitry, firmwarethat stores instructions executed by programmable circuitry, and anycombination thereof. The control circuit may, collectively orindividually, be embodied as circuitry that forms part of a largersystem, for example, an integrated circuit (IC), an application-specificintegrated circuit (ASIC), a system on-chip (SoC), desktop computers,laptop computers, tablet computers, servers, smart phones, etc.Accordingly, as used herein “control circuit” includes, but is notlimited to, electrical circuitry having at least one discrete electricalcircuit, electrical circuitry having at least one integrated circuit,electrical circuitry having at least one application specific integratedcircuit, electrical circuitry forming a general purpose computing deviceconfigured by a computer program (e.g., a general purpose computerconfigured by a computer program which at least partially carries outprocesses and/or devices described herein, or a microprocessorconfigured by a computer program which at least partially carries outprocesses and/or devices described herein), electrical circuitry forminga memory device (e.g., forms of random access memory), and/or electricalcircuitry forming a communications device (e.g., a modem, communicationsswitch, or optical-electrical equipment). Those having skill in the artwill recognize that the subject matter described herein may beimplemented in an analog or digital fashion or some combination thereof.

As used in any aspect herein, the term “logic” may refer to an app,software, firmware and/or circuitry configured to perform any of theaforementioned operations. Software may be embodied as a softwarepackage, code, instructions, instruction sets and/or data recorded onnon-transitory computer readable storage medium. Firmware may beembodied as code, instructions or instruction sets and/or data that arehard-coded (e.g., nonvolatile) in memory devices.

As used in any aspect herein, the terms “component,” “system,” “module”and the like can refer to a computer-related entity, either hardware, acombination of hardware and software, software, or software inexecution.

As used in any aspect herein, an “algorithm” refers to a self-consistentsequence of steps leading to a desired result, where a “step” refers toa manipulation of physical quantities and/or logic states which may,though need not necessarily, take the form of electrical or magneticsignals capable of being stored, transferred, combined, compared, andotherwise manipulated. It is common usage to refer to these signals asbits, values, elements, symbols, characters, terms, numbers, or thelike. These and similar terms may be associated with the appropriatephysical quantities and are merely convenient labels applied to thesequantities and/or states.

A network may include a packet switched network. The communicationdevices may be capable of communicating with each other using a selectedpacket switched network communications protocol. One examplecommunications protocol may include an Ethernet communications protocolwhich may be capable permitting communication using a TransmissionControl Protocol/Internet Protocol (TCP/IP). The Ethernet protocol maycomply or be compatible with the Ethernet standard published by theInstitute of Electrical and Electronics Engineers (IEEE) titled “IEEE802.3 Standard”, published in December, 2008 and/or later versions ofthis standard. Alternatively or additionally, the communication devicesmay be capable of communicating with each other using an X.25communications protocol. The X.25 communications protocol may comply orbe compatible with a standard promulgated by the InternationalTelecommunication Union-Telecommunication Standardization Sector(ITU-T). Alternatively or additionally, the communication devices may becapable of communicating with each other using a frame relaycommunications protocol. The frame relay communications protocol maycomply or be compatible with a standard promulgated by ConsultativeCommittee for International Telegraph and Telephone (CCITT) and/or theAmerican National Standards Institute (ANSI). Alternatively oradditionally, the transceivers may be capable of communicating with eachother using an Asynchronous Transfer Mode (ATM) communications protocol.The ATM communications protocol may comply or be compatible with an ATMstandard published by the ATM Forum titled “ATM-MPLS NetworkInterworking 2.0” published August 2001, and/or later versions of thisstandard. Of course, different and/or after-developedconnection-oriented network communication protocols are equallycontemplated herein.

Unless specifically stated otherwise as apparent from the foregoingdisclosure, it is appreciated that, throughout the foregoing disclosure,discussions using terms such as “processing,” “computing,”“calculating,” “determining,” “displaying,” or the like, refer to theaction and processes of a computer system, or similar electroniccomputing device, that manipulates and transforms data represented asphysical (electronic) quantities within the computer system's registersand memories into other data similarly represented as physicalquantities within the computer system memories or registers or othersuch information storage, transmission or display devices.

One or more components may be referred to herein as “configured to,”“configurable to,” “operable/operative to,” “adapted/adaptable,” “ableto,” “conformable/conformed to,” etc. Those skilled in the art willrecognize that “configured to” can generally encompass active-statecomponents and/or inactive-state components and/or standby-statecomponents, unless context requires otherwise.

The terms “proximal” and “distal” are used herein with reference to aclinician manipulating the handle portion of the surgical instrument.The term “proximal” refers to the portion closest to the clinician andthe term “distal” refers to the portion located away from the clinician.It will be further appreciated that, for convenience and clarity,spatial terms such as “vertical”, “horizontal”, “up”, and “down” may beused herein with respect to the drawings. However, surgical instrumentsare used in many orientations and positions, and these terms are notintended to be limiting and/or absolute.

Those skilled in the art will recognize that, in general, terms usedherein, and especially in the appended claims (e.g., bodies of theappended claims) are generally intended as “open” terms (e.g., the term“including” should be interpreted as “including but not limited to,” theterm “having” should be interpreted as “having at least,” the term“includes” should be interpreted as “includes but is not limited to,”etc.). It will be further understood by those within the art that if aspecific number of an introduced claim recitation is intended, such anintent will be explicitly recited in the claim, and in the absence ofsuch recitation no such intent is present. For example, as an aid tounderstanding, the following appended claims may contain usage of theintroductory phrases “at least one” and “one or more” to introduce claimrecitations. However, the use of such phrases should not be construed toimply that the introduction of a claim recitation by the indefinitearticles “a” or “an” limits any particular claim containing suchintroduced claim recitation to claims containing only one suchrecitation, even when the same claim includes the introductory phrases“one or more” or “at least one” and indefinite articles such as “a” or“an” (e.g., “a” and/or “an” should typically be interpreted to mean “atleast one” or “one or more”); the same holds true for the use ofdefinite articles used to introduce claim recitations.

In addition, even if a specific number of an introduced claim recitationis explicitly recited, those skilled in the art will recognize that suchrecitation should typically be interpreted to mean at least the recitednumber (e.g., the bare recitation of “two recitations,” without othermodifiers, typically means at least two recitations, or two or morerecitations). Furthermore, in those instances where a conventionanalogous to “at least one of A, B, and C, etc.” is used, in generalsuch a construction is intended in the sense one having skill in the artwould understand the convention (e.g., “a system having at least one ofA, B, and C” would include but not be limited to systems that have Aalone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). In those instances where aconvention analogous to “at least one of A, B, or C, etc.” is used, ingeneral such a construction is intended in the sense one having skill inthe art would understand the convention (e.g., “a system having at leastone of A, B, or C” would include but not be limited to systems that haveA alone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). It will be furtherunderstood by those within the art that typically a disjunctive wordand/or phrase presenting two or more alternative terms, whether in thedescription, claims, or drawings, should be understood to contemplatethe possibilities of including one of the terms, either of the terms, orboth terms unless context dictates otherwise. For example, the phrase “Aor B” will be typically understood to include the possibilities of “A”or “B” or “A and B.”

With respect to the appended claims, those skilled in the art willappreciate that recited operations therein may generally be performed inany order. Also, although various operational flow diagrams arepresented in a sequence(s), it should be understood that the variousoperations may be performed in other orders than those which areillustrated, or may be performed concurrently. Examples of suchalternate orderings may include overlapping, interleaved, interrupted,reordered, incremental, preparatory, supplemental, simultaneous,reverse, or other variant orderings, unless context dictates otherwise.Furthermore, terms like “responsive to,” “related to,” or otherpast-tense adjectives are generally not intended to exclude suchvariants, unless context dictates otherwise.

It is worthy to note that any reference to “one aspect,” “an aspect,”“an exemplification,” “one exemplification,” and the like means that aparticular feature, structure, or characteristic described in connectionwith the aspect is included in at least one aspect. Thus, appearances ofthe phrases “in one aspect,” “in an aspect,” “in an exemplification,”and “in one exemplification” in various places throughout thespecification are not necessarily all referring to the same aspect.Furthermore, the particular features, structures or characteristics maybe combined in any suitable manner in one or more aspects.

In this specification, unless otherwise indicated, terms “about” or“approximately” as used in the present disclosure, unless otherwisespecified, means an acceptable error for a particular value asdetermined by one of ordinary skill in the art, which depends in part onhow the value is measured or determined. In certain embodiments, theterm “about” or “approximately” means within 1, 2, 3, or 4 standarddeviations. In certain embodiments, the term “about” or “approximately”means within 50%, 20%, 15%, 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%,0.5%, or 0.05% of a given value or range.

In this specification, unless otherwise indicated, all numericalparameters are to be understood as being prefaced and modified in allinstances by the term “about,” in which the numerical parameters possessthe inherent variability characteristic of the underlying measurementtechniques used to determine the numerical value of the parameter. Atthe very least, and not as an attempt to limit the application of thedoctrine of equivalents to the scope of the claims, each numericalparameter described herein should at least be construed in light of thenumber of reported significant digits and by applying ordinary roundingtechniques.

Any numerical range recited herein includes all sub-ranges subsumedwithin the recited range. For example, a range of “1 to 10” includes allsub-ranges between (and including) the recited minimum value of 1 andthe recited maximum value of 10, that is, having a minimum value equalto or greater than 1 and a maximum value equal to or less than 10. Also,all ranges recited herein are inclusive of the end points of the recitedranges. For example, a range of “1 to 10” includes the end points 1 and10. Any maximum numerical limitation recited in this specification isintended to include all lower numerical limitations subsumed therein,and any minimum numerical limitation recited in this specification isintended to include all higher numerical limitations subsumed therein.Accordingly, Applicant reserves the right to amend this specification,including the claims, to expressly recite any sub-range subsumed withinthe ranges expressly recited. All such ranges are inherently describedin this specification.

Any patent application, patent, non-patent publication, or otherdisclosure material referred to in this specification and/or listed inany Application Data Sheet is incorporated by reference herein, to theextent that the incorporated materials is not inconsistent herewith. Assuch, and to the extent necessary, the disclosure as explicitly setforth herein supersedes any conflicting material incorporated herein byreference. Any material, or portion thereof, that is said to beincorporated by reference herein, but which conflicts with existingdefinitions, statements, or other disclosure material set forth hereinwill only be incorporated to the extent that no conflict arises betweenthat incorporated material and the existing disclosure material.

In summary, numerous benefits have been described which result fromemploying the concepts described herein. The foregoing description ofthe one or more forms has been presented for purposes of illustrationand description. It is not intended to be exhaustive or limiting to theprecise form disclosed. Modifications or variations are possible inlight of the above teachings. The one or more forms were chosen anddescribed in order to illustrate principles and practical application tothereby enable one of ordinary skill in the art to utilize the variousforms and with various modifications as are suited to the particular usecontemplated. It is intended that the claims submitted herewith definethe overall scope.

What is claimed is:
 1. An electrosurgical instrument, comprising an endeffector, the end effector comprising: a first jaw, comprising: a firstelectrically conductive skeleton; a first insulative coating selectivelycovering portions of the first electrically conductive skeleton; andfirst-jaw electrodes comprising exposed portions of the firstelectrically conductive skeleton; a second jaw, wherein at least one ofthe first jaw and the second jaw is movable to transition the endeffector from an open configuration to a closed configuration to grasptissue therebetween, the second jaw comprising: a second electricallyconductive skeleton; a second insulative coating selectively coveringportions of the second electrically conductive skeleton; and second-jawelectrodes comprising exposed portions of the second electricallyconductive skeleton; and an electrical circuit configured to transmit abipolar RF energy and a monopolar RF energy to the tissue through thefirst-jaw electrodes and the second-jaw electrodes, wherein themonopolar RF energy shares a first electrical pathway and a secondelectrical pathway defined by the electrical circuit for transmission ofthe bipolar RF energy.
 2. The electrosurgical instrument of claim 1,wherein the electrical circuit defines a third electrical pathwayseparate from the first electrical pathway and the second electricalpathway.
 3. The electrosurgical instrument of claim 2, wherein the endeffector comprises a cutting electrode electrically insulated from thefirst electrically conductive skeleton and the second electricallyconductive skeleton.
 4. The electrosurgical instrument of claim 3,wherein the cutting electrode is configured to receive a cuttingmonopolar RF energy through the third electrical pathway.
 5. Theelectrosurgical instrument of claim 4, wherein the cutting electrode isconfigured to cut the tissue with the cutting monopolar RF energy aftercoagulation of the tissue has commenced with the bipolar RF energy. 6.The electrosurgical instrument of claim 3, wherein the cutting electrodeis centrally located in one of the first jaw and the second jaw.
 7. Theelectrosurgical instrument of claim 4, wherein the end effector isconfigured to simultaneously deliver the cutting monopolar RF energy andthe bipolar RF energy to the tissue.
 8. The electrosurgical instrumentof claim 1, wherein the first-jaw electrodes comprise a first distal-tipelectrode, and wherein the second-jaw electrodes comprise a seconddistal-tip electrode.
 9. The electrosurgical instrument of claim 8,wherein first electrically conductive skeleton and the secondelectrically conductive skeleton are energized simultaneously to deliverthe monopolar RF energy to a tissue surface through the first distal-tipelectrode and the second distal-tip electrode.
 10. The electrosurgicalinstrument of claim 1, wherein the second jaw comprises a dissectionelectrode extending along a peripheral surface of the second jaw.
 11. Anelectrosurgical instrument, comprising: an end effector, comprising: atleast two electrode sets; a first jaw; and a second jaw, wherein atleast one of the first jaw and the second jaw is movable to transitionthe end effector from an open configuration to a closed configuration tograsp tissue therebetween, and wherein the end effector is configured todeliver a combination of bipolar RF energy and monopolar RF energy tothe grasped tissue from the at least two electrode sets; and anelectrical circuit configured to transmit the bipolar RF energy and themonopolar RF energy, wherein the monopolar RF energy shares an activepathway and a return pathway defined by the electrical circuit fortransmission of the bipolar RF energy.
 12. The electrosurgicalinstrument of claim 11, wherein the at least two electrodes setscomprise three electrical interconnections that are used together in theelectrical circuit.
 13. The electrosurgical instrument of claim 11,wherein the at least two electrodes sets comprise three electricalinterconnections that define at least a portion of the electricalcircuit and another separate electrical circuit.
 14. The electrosurgicalinstrument of claim 13, wherein the separate electrical circuit leads toa cutting electrode of the at least two electrode sets that is isolatedand centrally located in one of the first jaw and the second jaw. 15.The electrosurgical instrument of claim 14, wherein the cuttingelectrode is configured to cut the tissue after coagulation of thetissue has commenced using second and third electrodes of the at leasttwo electrode sets.
 16. The electrosurgical instrument of claim 15,wherein the at least two electrode sets are configured to simultaneouslydeliver the monopolar RF energy and the bipolar RF energy to the tissue.17. An electrosurgical instrument, comprising: an end effector,comprising: a first jaw; and a second jaw, wherein at least one of thefirst jaw and the second jaw is movable to transition the end effectorfrom an open configuration to a closed configuration to grasp tissuetherebetween, and wherein the second jaw comprises a composite skeletonof at least two different materials that are configured to selectivelyyield electrically conductive portions and thermally insulted portions.18. The electrosurgical instrument of claim 17, wherein the compositeskeleton comprises a titanium ceramic-composite.
 19. The electrosurgicalinstrument of claim 18, wherein the composite skeleton comprises: aceramic base; and a titanium crown attachable to the ceramic base. 20.The electrosurgical instrument of claim 17, wherein the compositeskeleton is partially coated with an electrically insulative material.21. A method for manufacturing a jaw of an end effector of anelectrosurgical instrument, the method comprising: preparing a compositeskeleton of the jaw by fusing a titanium powder with a ceramic powder ina metal injection molding process; and selectively coating the compositeskeleton with an electrically insulative material to yield a pluralityof electrodes.